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Providing clinically based insights to resolve complex insurance claim denials

We work with you to provide clinically based insights to resolve complex insurance claim denials

For select cases, PHM can apply its deep clinical expertise and knowledge of the latest treatments/tests available in medicine to advise during the appeals process.

Advise on Coverage Decisions

Provide employer/employee with an unbiased, trusted, clinically capable team who can advise on whether the denied treatment is rational, has been properly sequenced relative to prior interventions, and has a reasonable expectation of making a significant positive impact on outcomes of the case. This can lead directly to a discrete coverage decision.

Suggest Potential Alternative Therapeutic Options

Provide employer/employee with a science backed, clinically robust perspective on whether the treatments being contemplated are worth pursuing and/or if there are other potentially more effective alternative therapeutic options.

Provide Administrative Relief

Extract benefits leaders and team from a process where they do not possess the requisite clinical capability or expertise.

Foster Positive Employee Relations

Demonstrate to employees that the company is working on their behalf – providing timely access to a trusted team to help educate and guide them as they navigate the complex healthcare ecosystem.

Identify Patterns in Employee Health Needs

Investigate opportunities for systemically addressing cost and quality gaps.

We bring a unique combination of science, risk management, and health and business operations knowledge to deliver integrated insights to company’s pressing health risk issues.

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