Next Generation Benefits & Services

Next Generation Benefits & Services

NEXT GENERATION BENEFITS AND SERVICES

Our services provide the tools, resources, both insurance and non-insurance a company needs to bring down the ever-rising healthcare cost!

Yes, we offer the “Status Quo” group health insurance, but we decided that employers deserve much more from their benefit advisors.    We know that the Next Generation Benefits gives you the best of all worlds when it comes to bringing down cost while providing quality coverage to your employees.  Cost that the employee can see both in premium and in out pocket expenses.

UNDERSTANDING NEXT GENERATION BENEFITS

Skyrocketing health insurance cost are stealing profits and undermining wage increases.  As companies struggle to pay rising premiums year over year, the quality of benefits continues to decline. This rise in cost is unsustainable for the country, for companies, employees and their families.

Our services use a supply chain management strategy to provide health benefits to companies.   Just like companies using supply chain management to manage other aspects of their business.

Not only can Employers find massive savings in their  health benefit / insurance coverage, but also in 5 key areas in The Healthcare Supply Chain:

  • Identifying the Problem
  • Going to the Doctor
  • Getting Diagnosed
  • Finding a Solution
  • Getting Post Care Support

SIMPLIFIED SUPPLY CHAIN HEALTHCARE MANAGEMENT

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SUPPLY CHAIN HEALTH BENEFITS MANAGEMENT

What does this mean?

Supply Chain Management (SCM) is the active management of supply chain activities to maximize customer value and achieve sustainable competitive advantage. It means to develop and run supply chains in the most effective and efficient ways possible. Hamilton Edwards “simplifies” the process for their clients.

Supply chain activities in the Health Benefits arena cover everything from product development, sourcing, integration, and logistics. Finally, strong coordination and cooperation with the service providers is needed pulling it all together with a solid IT and administrative services platform. 

The concept of Supply Chain Management (SCM) is based on two core ideas:

  • The first is that practically every product that reaches an end user represents the cumulative effort of multiple organizations. These organizations are referred to collectively as the supply chain.
  • The second idea is that while health insurance companies have worked with supply chain systems for a long time, most worked only within the “four walls”. Few organizations understood, much less managed, the entire chain of activities that ultimately delivered solid health benefits simply to the employer and their employees. 

PATIENT ADVOCACY & CONCIERGE SERVICES

Medical Health Advisor

  • Represents you and helps you get through the maze of administrative, insurance and clinical issues
  • Helps you find the right providers and services
  • Clarifies health benefits
  • Provides cost estimates for medical procedures

Personal Telephonic Counseling

  • Access to counselors who assist with problem resolution 24/7.  Speak to Skilled Counselors for depression, anxiety, or stress; conflicts at work or home; reliance on alcohol, drugs, tobacco or food; sexual, physical or emotional abuse; loss and grief; change and transition 

HealthAdvocate™ |  Core Health Advocacy Service

One simple call to our toll-free number is all it takes to get help with virtually any healthcare or insurance-related issue.

Each employee is assigned a Personal Health Advocate, typically an experienced registered nurse supported by medical Directors and benefits and claims specialists.  From finding an in-network specialist... to untangling a medical bill... to clarifying benefits, our Personal Health Advocates know the ins and outs of these complicated systems to get the right answers, quickly and efficiently.

Our work to resolve the issue begins immediately, including research, contacting doctors and health insurers, and completing paperwork to get to the most comprehensive resolution.  Best of all, employees work with the same Personal Health Advocate until their issue is completely resolved, and are free to contact them for any follow-up needs. 

HealthAdvocate™ |  Help with Multiple Issues

A single, toll-free number connects employees to a Personal Health Advocate, who can help resolve a wide range of clinical, claims, coverage and billing issues.  This includes:

  • Finding qualified doctors, hospitals, dentists and other providers nationwide
  • Identifying top medical institutions and clinical trials
  • Locating leading doctors, hospitals and other providers for second opinions
  • Scheduling earliest appointments with hard-to-reach specialist; arranging for specialized treatments and tests
  • Estimating and understanding healthcare costs to help them make informed decisions
  • Clarifying complex conditions; researching available treatment options

HealthAdvocate Pic

 CLICK HERE for HealthAdvocate™ Brochure

PRESCRIPTION ADVOCACY

Shared Health Alliance™ | SHARx™ Rx Assistance - Individual

What SHARx is:

  • Alternative Access Point to medications
  • A program that works through multiple avenues to find your medication
  • Members often get their medications for FREE
  • Drugs that are not free are typically available at 75% to 90% off retail
  • Access to just about any maintenance medication
  • Includes access to specialty medications and orphan drugs
  • No longer be financially crippled by high-cost drug expenses

What SHARx™ is NOT:

  • SHARx™ is not a discount program.  Members typically receive their medications for free or at a small cost share.

CLICK HERE to get the SHARx™ Individual Health Flyer

Shared Health Alliance™ | SHARx™ Rx - Group

Similar to Your Current Rx Program:

  • Employees have a drug card with co-pays
  • 85% of your employees will access meds with no charge
  • 15% will be re-directed through Advocacy and typically get their medications for free

A "True Rx" Partnership:

  • All prescriptions under $350 purchased at the pharmacy
  • True Rx communicates with employees to access high-cost drugs over $350 through Advocacy
  • Employer health plan is not billed for any drugs accessed through Advocacy
  • If SHARx™ Advocacy cannot assist member, access is granted through the pharmacy
  • True Rx does not markup generic drugs - savings is typically 30-60% on drugs that are purchased at the pharmacy

A Positive Member Experience:

  • Employer provides Rx data file 60 days prior to inception date
  • HR team partners with SHARx™ / True Rx to assist the 15% of high-cost utilizers get started with Advocacy
  • Employees are through Advocacy prior to or by the inception date of the program
  • Employees' co-pay for their drugs are typically eliminated
  • Employer's cost go down by 70%

CLICK HERE to get the SHARx™ Group Health Flyer

TELEMEDICINE / E-DOC / TRAVEL ASSIST

Network of Physicians available 24/7/365 who can diagnose, treat and prescribe medication to you by phone while you are in your bunny slippers.  There is no cost to the employee or their family for the consult.  This service becomes a “gatekeeper” to the employer health plan.

  • Email access to medical team of board certified doctors
  • Smartphone App access to medical team along with health assessments
  • Ask any medical or health questions, get personal direct answers
  • Represents employee and helps get them though the maze of administration, insurance and clinical issues
  • Provide cost estimates
  • Helps find the right providers, services and clarifies health benefits
  • Highly experienced negotiating unit that uses various fee bench-marking databases.  Negotiates medical and dental bills over $400.
  • Key part of any employer package that brings solid value to the employees and is essential for protection and large cost exposure from health plans.
  • Program for employees who have limited incomes and resources
  • Pharmaceutical companies and advocacy works with employee
  • Medical services for C-Suite and Key Managers or Personnel.  Pay an annual membership fee that covers most services.
  • Gap insurance that pays out $50,000 to $100,000 in medical and dental expenses for key employees.

 CLICK HERE for healthPerx™ Telehealth Brochure

BILLING ADVOCACY

HealthAdvocate™ | Expert Help When it is Needed Most

  • Resolving insurance claims; uncovering billing errors; negotiating payment arrangements
  • Finding options for non-covered services; negotiating provider discounts
  • Answering questions about test results, treatments and medications recommended or prescribed by the physician
  • Addressing eldercare issues; clarifying Medicare; locating adult day care, assisted living and long-term care; researching transportation to appointments
  • Assisting with special needs; finding caregiver support services, in-home care, rehabilitation resources and hospice; expediting coverage for special procedures and medical equipment
  • Negotiating pre- and post-claim fees for medical cost savings 

 

Contact us for more information about how Hamilton Edwards can bring better solutions at a lower cost to your company's health care benefits.

Telephone

Main-line:    704-375-1112

Customer Service
Ext 104
Sales
Ext. 105
Admin
Ext. 107
The Buck Stops Here!
Ext. 103

 

 

Contact us

Hamilton Edwards, Inc.
9101 Southern Pine Blvd, Ste 320
Charlotte, NC 28273

[email protected]

 

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704-375-1112

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