Employee Service Model 15. What services do you handle on employees’ behalf vs requiring our company or carriers to handle? • Rather than refer employees directly to a carrier to address their needs, our team prefers to work directly with the member in order to ensure that their needs are met in an accurate and efficient manner. Yates takes a hands on approach, working with your employees to resolve all benefit related questions, such as coverage details, claims, EOB’s, benefit changes due to life events, etc. 16. Do you provide employees with claims assistance at initial claim? At appeal? • Our clients have dedicated claims advocates on staff that assist employees with all claim related items from the date a claim is initiated, all the way up until it is satisfied by the carrier. In the event of an appeal, we will continue to support all members during the process, acting on their behalf with the insurance company and provider to satisfy all issues surrounding an appeal. 17. Do you provide regular employee advocacy to include assisting employees with claims substantiation, RX claims support, medical claims support, dental and vision claims support, assistance with the employer sponsored life insurance and LTD claims? • Yes, Yates has an outstanding service team with many years of experience working with employers and individuals to properly support all matters in regards to claims for the lines of coverage mentioned. We work directly with our clients from the initial filing of the claim, through communications with the carrier, all the way up until claims are properly satisfied and paid. 18. Do you provide in-person employee advocacy? • Our agency will certainly provide in-person advocacy and assistance for any individual in need of personalized service for all insurance related matters. Yates local service team conducts many in- person meetings with clients on-site, as well ensuring our office is available to employees on an individual basis.
19. Do you offer any 800 phone line or other number for employees to contact you? What types of issues do you assist with?
• Yates has a dedicated and direct line for employees and their families to assist with any general/specific questions or issues that may arise. Our experienced and knowledgeable team is willing to advise on all aspects of your companies insurance program, including but not limited to: o Enrollment Assistance o Claims o Benefits and Coverage Questions o Access to Care
o Rx and Pharmacy o EOB Assistance o Network and Provider Access o HSA/HRA/FSA Support o COBRA Facilitation
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