Employees do not read benefit guides. They ask questions.
Most of what an employee needs is not a claims dispute. It is a quick, correct answer about whether something is covered, before a small question becomes a large problem. That is a different service from claims advocacy, and it has to exist at the hour the question occurs rather than during open enrollment.
The same questions, in the same order, every year.
None of these require a benefits background to answer well. They require access to the plan documents, the network and someone who will pick up.
Is this covered, and what will it cost me
Asked before a visit, a procedure or a prescription. Answered correctly, it prevents a surprise bill and a dispute later. Answered with “check your booklet,” it becomes both. The answer depends on whether the service needs prior approval, where the employee stands against the deductible and out-of-pocket maximum, and which tier a prescription falls in. We check those against the plan documents and the carrier’s records before giving an estimate.
Is This Provider in Network
Directories are imperfect and facilities employ out-of-network practitioners. Checking properly takes a few minutes and saves an appeal. The trap is an in-network hospital with an anesthesiologist, radiologist or lab that is not. We check the facility and the individual provider, and where the No Surprises Act applies, we explain what the employee can and cannot be billed.
My Card, My Dependent, My Deductible
ID cards, adding a newborn, what counts toward the deductible, whether a spouse’s plan pays first. Routine, high-volume, and exactly what HR should not be spending its week on. Several carry a deadline, such as the special enrollment window for a new baby, so a same-day answer matters. When a spouse has other coverage, we sort out which plan pays first before claims stall.
Around the clock, and escalating to a person when it should.
Employees have benefits questions in the evening and at weekends, because that is when they are dealing with their own lives.
Our Chat, at Any Hour
The chat on our site is open at any hour. A person from CFH answers it live when we are in, and a question left after hours is answered the next business day. Questions that need a claim looked at or a carrier called are passed to your account team rather than left in the chat window.
A Person on Your Account
The customer service seat on your service team knows your plan. Employees are not routed into a general queue to explain their plan to a stranger. That seat is backed by the account manager and plan analyst on the same team, so a question that turns out to be a billing or eligibility problem moves to the right person without starting over.
Busiest Week Covered
Real-time support during open enrollment, when question volume peaks and the deadline is least forgiving. Employees can call us to talk through which plan fits their situation, including expected doctor visits, prescriptions and whether a spouse has other coverage. That takes pressure off HR in the week elections are due.
The cheapest time to answer a question is before the claim.
Fewer Disputes
A question answered before a visit is a denial that never happens, an appeal nobody writes and a balance bill nobody has to contest. It also keeps HR out of the follow-up, since a dispute tends to land on HR’s desk once the employee runs out of patience with the carrier. Recurring questions show where the enrollment material was unclear, and we rewrite it before the next open enrollment.
An HR Team That Gets Its Time Back
For an HR department of one, this is the single largest recovery of hours available in a benefits program. Those hours go on repeat questions that need plan documents and a carrier phone line, not HR judgment. Moving them to us leaves HR with the decisions that need someone inside the company. See how we support an HR team of one.
A Plan Employees Trust
Satisfaction with benefits tracks access to answers more closely than it tracks plan richness. Employees forgive a deductible. They do not forgive being unable to get a straight answer. A plan people understand also gets used the way it was designed, which is where the savings in a plan design actually come from.
What employers ask about concierge support.
How is this different from claims advocacy?
Timing. Advocacy fixes something that has already gone wrong. Concierge answers the question before it does — whether a service is covered, what it will cost, whether a provider is in network. Employees do not need to know which one they need. They reach the same team, and a question that turns into a denial moves into claims advocacy without starting over.
Do employees have to go through HR?
No. They come to us directly, which is the only version that works, because most of these questions arrive in the evening or at a weekend when people are dealing with their own lives. It also keeps medical details away from HR, which protects the employee’s privacy and keeps HR out of information it should not hold.
Does answering questions actually change cost?
At the margin, yes. A member who learns what something will cost before they go is the cheapest intervention in benefits, and it prevents the dispute that would otherwise follow. The costs it catches are unplanned out-of-network care and incorrect bills. In a self-funded or level-funded plan, claims that never happen stay in the employer’s claims fund rather than with the carrier.
An employee benefits concierge in Bloomfield Hills for employers tired of chasing claims
In a lot of small and mid-size companies, HR is also the benefits help desk. A claim gets denied, an ID card never arrives or a bill looks wrong, and the employee walks straight to HR. An employee benefits concierge in Bloomfield Hills takes those problems off your desk.
We are an independent employee benefits consulting firm on Woodward Avenue, in business since 2007. We work with employers in Troy, Royal Oak, Rochester Hills and across Michigan.
Employee Benefits Concierge
A benefits concierge is a person your employees can call when their benefits are not working. We take the problem, contact the carrier or the plan’s administrator and follow it until it is fixed. Then we report back.
Common requests include:
- A claim that was denied or paid wrong
- A missing or wrong ID card
- A doctor or drug that is not in the network
- Adding a spouse or a new baby after a life event
- A payroll deduction that does not match the bill
We do not pay or process claims. The carrier does that. Our job is to keep pressing the carrier and the administrator until the answer is right.
For proper coverage of an account we work in teams of 5: an account executive, an account manager, a plan analyst, customer service and IT. Your employees are not stuck waiting for one person to come back from vacation. Our chat assistant also answers around the clock.
What should an employee do when a health claim is denied?
Start with the Explanation of Benefits, or EOB. It is the statement the carrier sends after a claim. It shows what was billed, what the plan paid and why.
Next, look for simple causes. Common ones are a billing code error, an out-of-network provider or a missing prior approval. Many denials get fixed with one call to the doctor’s office.
If the claim is still denied, file an appeal. The denial letter lists the deadline. Do not let it pass. This is where a benefits concierge helps most. We deal with carriers every day and keep pushing until there is an answer.
Should HR handle employee claim problems?
It is better if HR does not. Claim problems often involve medical details that HR should not see. When employees bring those issues to us, HR stays out of private health information.
It also saves time. Claim calls take time. Handing them off frees that time for hiring, training and everything else on the list.
Common questions
Does the concierge cover more than medical?
Yes. It covers the plans we place with you, including dental, vision, life, disability and voluntary plans. Employees use one contact for every plan, which matters most for voluntary coverage such as accident or critical illness, where a benefit only pays if the employee knows to file a claim after a qualifying event.
Can employees reach you after hours?
Our team answers during the workday. Our chat assistant answers around the clock. So an employee can get an answer on a Sunday night, and anything that needs a person, such as a denied claim, goes straight to the account team to pick up.
Do we have to change carriers to get this?
No. Switching brokers takes one broker of record letter. Your carrier, plan, cards and rates stay the same. The letter tells the carrier to recognize us as your broker. It does not change the policy, the renewal date or the network, and employees simply start calling us. See how to switch to CFH.
Talk to us about an employee benefits concierge in Bloomfield Hills
Send us your renewal or book a 30-minute call. We will show you how employee questions would reach us instead of HR. Visit us at 41000 Woodward Avenue, Suite 350 East, Bloomfield Hills, MI 48304, or call 248.370.8853.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
Switch to CFH. Unhappy with your broker? Your employees won’t notice. You will. →