Insurance Technology Featured Article

PAF and Aetna Unveil a Program for Tackling Coverage Problems

February 19, 2013

Patient Advocate Foundation has strengthened its strategic association with Aetna, wherein members will be offered comprehensible and accessible healthcare. As part of the collaboration, the two organizations will now assist members in tackling the extremely intricate access and coverage problems of the healthcare system.

The Aetna Clinical Appeals Care Line will provide custom designed data and assets which can be leveraged by members with complex healthcare cases; thereby ensuring the required care is received. Members are ably assisted by Aetna through its Care Line, which offers the required support. Members are therefore able to take positive preferences and lead a better life.

In a statement, James D. Cross, M.D., Head, National Medical Policy and Operations, Aetna said, "We are proud that nearly 92 percent of our group medical members are satisfied with the service they get from Aetna. But sometimes they need financial support and assistance to supplement what their health plan covers. We are glad to offer a resource that helps members maximize their coverage, connect to community support and make informed healthcare decisions."

The appeals process at Aetna refers Aetna members who can leverage the services. PAF can be availed by members via the Care Line. Specialized case managers working at PAF’s Mission Delivery team operate this special phone line. When members are confronted with issues, the case managers advantageously utilize their comprehension of coverage problems, healthcare assets and clinical experience for offering solutions on their own.

The case mangers carry out in-depth studies and resolve issues related to claims pending coverage. They help members during the selection and enrollment procedures for Medicare, Medicaid and Disability. The case managers also aid members by providing recommendations to local, state or federal assets.

According to Beth Patterson, president, Mission Delivery at PAF, the organization is happy to assist Aetna members especially when possible obstructions to the healthcare system cannot be conquered via a health plan only.

Nancy Davenport-Ennis, founder and CEO, PAF said, "Aetna members now have another dedicated support team for clinically complex issues. They will appreciate the attention, expertise and guidance of PAF."




Edited by Brooke Neuman

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