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 and trusted clinically capable team who can advise on whether the denied treatment is rational. This can lead directly to a discrete coverage decision.

Suggest Potential Alternative Therapeutic Options

Provide employer/employee with science-backed, clinically robust perspectives 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.