A new guide to the medical maze
A startup helps employees who are sick of navigating the health-care bureaucracy.
By Michelle Andrews

NEW YORK (FORTUNE Small Business Magazine) - Barbara Snyder had gotten used to fielding half-a-dozen calls a day from employees needing her help with tangled health-insurance problems.

But in all of last year, the vice president for human resources at Atlantic American Corp. (Research), a holding company for a group that sells property, casualty, life, and health insurance, estimates she handled just six such calls--even though the Atlanta-based company switched its 250 employees to an unfamiliar "consumer-driven" health plan.

Why was Snyder's phone so quiet?

Shortly after it adopted a new health insurer, her company signed on with a separate company called Health Advocate, whose specialists deal with employees' concerns about health care and health insurance. Snyder says now she and her two colleagues can focus on the workforce and payroll issues that they know best. "I can't imagine a small company such as ours trying to make it through the muddy waters of health care these days without help," she says.

Health Advocate, based in Plymouth Meeting, Pa., was launched by five former Aetna (Research) execs who see a ripe business opportunity in the rising complexity of health care. As costs increase, employers have shifted more of them to employees through higher copayments, co-insurance, preferred-drug lists, and tiered costs for doctors and hospitals.

Consumer-directed health care, which generally combines a high-deductible health plan with a pot of money for employees to use to pay for health expenses, is gaining ground, with 13% of small employers saying they expect to adopt such plans by 2008, according to a recent study by Mercer Health & Benefits. And the increasing sophistication of medical care, while prolonging and enhancing lives, confronts patients with complicated choices about specialists and treatment options.

It's no wonder that employers and workers alike are looking for a guide through the maze.

The founders of Health Advocate were not the first to see this opportunity, but they have built their firm into the largest in this nascent industry, with about $8 million in 2005 revenues. The 73 trained advisors--including 20 nurses--at Health Advocate's call center help the employees of client firms find a specialist, appeal a denied claim, research treatment options, even locate a long-term-care facility for an elderly parent.

Says Dr. Abbie Leibowitz, 59, co-founder and chief medical officer: "We're either the single place to go with questions or the single place to go if you don't know where to go."

When Lane Watson, 38, was diagnosed with stage-four colon cancer, Health Advocate figured out which specialist he needed to see and helped schedule his visit. "When you are diagnosed with cancer, your life turns into this big blur," says Watson, who served as an operations manager at Vendor Efficiencies, a logistics company in Austell, Ga. "My advocate said, 'I'm experienced, and this is what you should do.'"

Other health problems that aren't life-threatening are often vexing nonetheless. Joanne Harmelin, CEO of Philadelphia-based Harmelin Media, an ad-placement agency, got a letter from a collection agency demanding $1,500 for back surgery she had undergone five years before. She turned the letter over to Health Advocate, which discovered a coding problem in the original bill and corrected the error.

"It saved me I don't know how many hours!" she says.

Health Advocate charges employers between $1.25 and $3.95 a month for every worker. That fee covers the employee, spouse, and any dependent children, as well as the employee's parents and parents-in-law. "The so-called sandwich generation is increasingly responsible for their parents, and this has become a very important feature for employees," says Marty Rosen, 59, co-founder and chief marketing officer for Health Advocate.

Small employers usually pay the higher fee, because their workers tend to use the service more: 15% to 20% of employees at a typical business with fewer than 100 employees use Health Advocate services over the course of a year, compared with just 8% to 10% of workers at larger companies. Word about the service and its capabilities tends to spread much more quickly at small firms, Leibowitz says.

Many small businesses sign on with Health Advocate when a difficult health situation is looming. "Right after they sign up, we get a call that someone needs a transplant, or someone's child has cancer, or that there's an ailing parent," says Leibowitz.

Of the 1.3 million employees covered by Health Advocate, 95% work for large firms. But of the more than 50 employers the company signs as new customers each month, 60% are small businesses.

Clients such as Atlantic American say they find that Health Advocate's specialists are far more knowledgeable and efficient than most in-house HR generalists, and give better and faster assistance to employees--an important selling point for firms whose HR staff, if they have one--is stretched to the limit.

But sometimes having a persistent advocate is more important than having a speedy one. After a car accident left Janice Schecter with terrible back pain, her advocate got on the phone with the insurer and a medical-supply company to sort out the roadblocks she encountered as she tried to get a piece of equipment her doctor had recommended.

"I was scared, but she wouldn't take no for an answer," says Schecter, an associate media director at Harmelin Media. "She was like a partner trying to get me the help I needed." At a time like that, there is no better benefit.


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