The Growing Need

Advocacy has become a necessary piece of the health care benefits package. Each year employers must devote more resources toward designing healthcare plans, communicating benefits, managing claims and resolving problems. Complicating this issue for HR personnel is the rising complexity of benefit and coverage issues. Many HR departments must allocate increasing hours to correct claim billing, coding and reimbursement errors. At the same time, expanding government regulations raise real and new concerns for liability. Employers must ask themselves if this is indeed a core-competency of HR, and if these highly specialized tasks could be managed more objectively, efficiently and resourcefully through outsourcing.

Advocacy and the HIPAA-ERISA Puzzle

The HIPAA Privacy Regulations greatly increase the need for employers to separate themselves from detailed health plan administration issues in order to safeguard themselves from liability over employee health information. To best protect themselves under HIPAA, employers should stop performing all advocacy and appeal duties. However this presents a great challenge under ERISA, as an employer has a fiduciary responsibility to help employees resolve plan problems. Outsourcing advocacy is the best and most cost effective solution to this dilemma. When employees use the assistance of the outsourced advocate, their information is kept confidential to comply with HIPAA, and their access to help with plan problems and issues satisfies the employer’s responsibilities under ERISA.