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.
Hear from our clients
“We have thankfully engaged Private Health since the very beginning of the pandemic. I found their solutions to be based in science, facts and the most current information from medical experts to keep our employees safe. Even in the most uncertain of times, they quickly adjusted protocols with an agile approach for each individual location’s need in a wide variety of employee challenges from the warehouse, to on-site child care and in retail locations across North America. They earned our trust and we have full confidence in ability to help us navigate the known and unknown challenges ahead.”
“Private Health has been a valued, trusted partner throughout the many twists and turns of Covid. Whether providing evidence-based protocol guidance, conducting employee educational webinars with panels of experts, or developing and implementing customized testing programs, Private Health has reliably helped us navigate Covid-related challenges. Access to experienced clinicians and researchers when we need them most helps us fulfill our commitments to our clients and colleagues.”