Patient Advocate/Nurse Navigator
“Nurse Navigators Enhancing The Group Medical Investment”
Employers and their workers are making ever increasing investments in company Group Medical Programs. Unfortunately, these stakeholders are not realizing the maximum return on this investment. OMCA’s Patient Advocate Program can help your employees become better consumers and maximize this investment.
To most employees, the bureaucratic maze of health care access, insurance reimbursements, co-pays and networks is daunting at best. OMCA’s Patient Advocate Program uses specialty trained clinical staff to assist employers and employees navigate the complex world of health insurance. We educate participants on making the most of their plan, and ensure that employers obtain the greatest return on their health care investment.
In a perfect world, insurance terms/regulations would be simple. Company Human Resource Departments would be fully staffed, Agency customer Service representatives would have free time to consult, physician offices would be ready accessible, and medical claims adjusters would not be outsourced overseas. In this utopia, employees and plan sponsors would have a myriad of resources to call upon. However, since this help is not available, many carriers, self-funded employers and TPA’s have called upon OMCA to institute a Patient Advocate / Nurse Navigator Program as the missing support structure.
- Coordinate care among various providers
- Arrange timely second opinions / specialist referrals
- Expedite diagnostic testing
- Translate EOB’s
- Address medical record issues
- Locate available social services support systems
- Assist with claims errors, denials and appeals
- Decode physician instructions
- Monitor patient accountability
- Explain / Assist with in-network / Out of network options
- Pharmaceutical options / Alternatives
These services are available nationwide to employers, carriers, self-funded entities and TPA’s for a modest PEPM Fee. For more information, contact Matthew Williams.
From our Clients & Colleagues
Scott R. Medical Benefits Mgr, of a 2000+ employee group
"OMCA gives 6 star service on a 5 star scale."