CareCounsel Health Advocacy

CareCounsel is available Monday thru Friday, 6:30am - 5:00pm PT. You can reach CareCounsel at (888) 227-3334. Resources are also available through the CareCounsel web site at www.carecounsel.com. CareCounsel is an autonomous subsidiary of Stanford Hospital & Clinics.

An advocate, known as Member Care Specialists at CareCounsel, can support and help you navigate the health care landscape. What can they help with?

Member Care Specialists do not provide medical advice or treatment. However, they are health care experts committed to providing exceptional service and education as you navigate the health care system.

Regardless of which company health plan you chose, CareCounsel is available to assist with any Medical, Dental, Vision or Rx concerns.

Guidance During Annual Enrollment...

• Educate about current and new health and ancillary health plan benefits and changes
• Compare health plan options and differences
• Find answers to questions not addressed in open enrollment materials
• Locate network doctors, hospitals and ancillary services
• Help with transitional care issues such as prior-authorization, medical record transfer, changing formulary, and maintaining appropriate supply of maintenance drugs
• Assist with enrollment and eligibility issues, such as obtaining ID cards
• Offer coverage information for out-of-area dependents thru the Affordable Care Act (ACA)

...And Throughout the Year

• Compare health plan options and differences
• Educate about healthcare benefits, coverage, terms and concepts
• Explain cost advantages of using network providers
• Assist or investigate possibilities of obtaining referrals and authorizations for required services both in and out of network
• Help to understand coordination of benefits with health and ancillary benefit providers
• Troubleshoot pharmacy issues including tiered Rx benefits and mail order
• Support with appeals and grievances

• Assit with locating doctors, hospitals and ancillary services using health provider’s on-line tools
• Confirm provider network status and scope of practice
• Troubleshoot prior authorization issues
• Assist with formulary or point-of-sale eligibility problems at the pharmacy
• Engage with health plan and hospital to ensure optimal care coordination, home care and discharge planning

Connecting you to world-class resources

CareCounsel coordinates your access to the well‐regarded Stanford Health Library in support of employee’s clinical health decisions. A comprehensive, confidential packet of information, personalized for you by a certified, medical librarian. When you contact CareCounsel we will identify your need for medical and health information, which could consist of:

• New diagnosis
• Treatment options
• Upcoming surgery
• Centers of Excellence

• Educate on claims processing and understanding explanation of benefits (EOB)
• Advocate to correct claim errors (COB, network discounts, UCR, plan design)
• Assist with claims submission and coding errors
• Coordinate with providers, medical groups, and facilities to resolve any billing disputes and inappropriate balance billing
• Troubleshooting issues with collection agencies and assisting in negotiating payment arrangements
• Review appeals and grievances process for denied claims

• Medicare Basics, Medicare Advantage and Medicare Supplement Plans (Parts A, B, C & D)
• Interaction with employer-sponsored health plans – including Coordination of Benefits
• Eligibility and enrollment process
• Provide clarity to common healthcare considerations facing retirees and pre-retirees
• Help understand formulary, tiered Rx benefits
• A series of ten 3-minute Medicare videos to help those transitioning into Medicare:
  • Do You Qualify for Medicare?
• • The A, B, C’s About Parts A & B
  • Rx = D Your insight to Part D
  • Advantages of an Advantage Plan
  • Closing the Gap on Medigap
  • Rolling into Enrollment
  • Health Savings Accounts as your Medicare Birthday Approaches
  • Avoiding Medicare Penalties
  • To-Do List
  • Your Healthcare. Your way.