S.O.W.ing the seed

Health Insurance is complicated, but it shouldn't have to be. That's the realization we came to when founding PA Health Advocates several years ago. The challenge is that to truly be on top of this market not only do you need to stay ahead of changes, but you have to be doing it for the right reasons. Because of the constant changes, we have seen several companies come and go in the health insurance space. We make a commitment to both you and your clients that, regardless of what happens, we aren't going anywhere. Our company was founded because of an overbilled medical expense that doubled costs to our founder and we are commited to helping as many clients as we can avoid similar mishaps. To us, we have a deep seated reason to help. Regardless of regulatory changes our job is to 1. be ahead of the changes. 2. articulate them to our stakeholders to ensure major changes can be managed effectively.

The reason we are able to help our clients stay ahead of the curve and help our partners with their clients questions is because of you. Our partners ensure that when people are struggling with a particular problem, they are routed to someone that can help. That is where we feel we make the most impact. We put a high value on this relationship and use it to sow the seeds of knowledge in our community.

Partnership Keys to Success

Clients Served: To us, it's not enough to meet your clients with our level of service. As an extension of your organization, if only by referral, we want to understand the level of service you provide to your clients. We look to meet your expectations first by giving your clients the same level of care they are acustomed to by you.
Clear Expectations:S.O.W. is our Scope of Work agreement we hold with all partners. It clearly identifies what your and our responsibilities are. We get this in writing. The SOW is a tool we use to define roles. Maybe you offer Employee Benefits services, but need assistance with Medicare or individual health. The SOW would stipulate that any employee benefits questions would be deferred back to your Benefits team. Maybe you are a P&C firm who handles disability applications. If the SOW states as such, we may come across a Self Employed Individual that you referred who asks about Disability Insurance, that we would refer back. Clear expectations ensure no suprises on either side.
Open Communication: Beyond service and clear expectations, regular updates on client interactions are important to us. It can be frustrating to refer a client to a partner and remain in the dark on outcomes the next time you see the client. Having up to date outcomes strengthens your relationship with your clients and delivers on the promise of referrals.

Examples of Current Partnerships?

Property and Casualty Agencies

After 30 years of having an in house Medicare team member, the member passed away leaving a void in Medicare support for clients. Serving a large book of business they turned to their GA for assistance. Too many dropped balls and they partnered with us. Our SOW stated that they will handle personal and commercial(p&c) lines, Employee Benefits, and we will manage Medicare Supplement, Medicare Advantage, Rx Plans, and Individual health lines(they didn't have an existing contact).

Life and Health Agencies

A life insurance agent focused in the business owner and executive market had fielded regular calls on Employee Benefits. Since he handled Section 457 arrangements for executives, the HR team naturally questioned what other benefits he was able to offer. Instead of getting into the weeds with healthcare, and in an effort to position himself as the executive specialist, our SOW was designed for us to coach rank and file employees on their options in the markets he serves.

Accountants and Financial Advisors

The individual market for people under 65 has several moving parts. The three submarkets are those retiring prior to 65, soloprenuers and employees of businesses with fewer than 50 employees. All three are the exact markets successful advisors work in. Our countless SOW's with Financial Advisors for both individual health and Medicare creates a relationship with existing clients and referrals who see us as a resource. They see us as an extension of the financial advisor, strengthening their relationship with clients. Equally, for those advisors in the business markets, whether doing succession planning, generational coaching, tax planning, or one of the other tasks at hand, our expertise in multiple markets positions you better.

Healthcare Systems and Providers

Although we tend not to be licensed in the same capacity as the healthcare system, our goals our aligned. For a patient to have lower out of pocket costs, and a provider to have higher claims paid, insurance is crucial. Our job is to ensure drug formularies are considered, providers are in network, and deductibles are manageable. For a healthcare system, our response, unlike a navigator, CAC, or assister, is that we have a no wrong door policy with a full shelf of plans both on exchange, off exchange, faith based and short term to meet your patients needs where they are at. Additional we have appication to approval methods to help constituents all the way through Medicaid and CHIP.

Press Statements

We're happy that in our current capacity we get invited by stakeholders around the US for input on current healthcare events. We are firm believers that the "squeeky wheel gets the oil." Because of the healthcare systems we are currently facing, we regularly speak at events federally in DC, regionally in Harrisburg, and locally in Lancaster. We've been called to comment on several pieces for the Lancaster Newspaper. This is due to continued education in the area of healthcare and interpretation of change. In the event CMS drops a new proposal for public comment, we tend to have it read within 72 hours depending on comment periods and flow of information. We are happy to partner with outlets.