Health Champion Health Champion has the expertise and experience to help you solve your medical and insurance health care problems.

Case Studies: Real Life Examples of How Health Champion Works For You!


Health Champion in Action - Case Studies

These case studies show how personal and professional health care advocate Health Champion helps you solve simple and complex medical treatment and insurance problems.

Please take a minute or two to read some real-life case-studies of how Health Champion has helped a variety of people, from a large employer to a single dad. You'll be amazed at the difference we can make.

How Health Champion Works with Individuals and Families

Making health savings accounts work for Cassie

"Cassie" has both a high deductible medical benefit plan and a Health Savings Account (HSA) that covers preventative services at 100%. Cassie thought her out of pocket expenses would be minimal since the only time she saw a doctor was for routine (preventative) services. However after a "routine" eye exam, her insurer said she would have to pay for the service since the claim was not considered preventative. Cassie's Human Resources contact brought the matter to the attention of their account manager who was unable to get the claim paid. Human Resources contacted Health Champion. Health Champion determined that the visit to the eye doctor was for routine eye care and was able to secure payment for Cassie.


Alex saves money in an emergency situation

Single dad "Alex" didn't know where to turn when his son was complaining of a terrible stomach ache in the middle of the night. His pediatrician's office was closed so he decided the local emergency room (ER) was his only option. He thought his insurance covered use of the ER.

He expected to pay his copay and nothing else. When he received a bill for the visit that his health plan refused to pay, he ignored the bill, thinking it was a mistake and that the health plan would "fix" it. After receiving collection notices, he called Health Champion for help.

Health Champion:

  • Got the collection agency to place a hold on the collection action for 30 days.
  • Obtained the ER records to determine if the services obtained during the visit were reflected in the claim submitted to the insurance company.
  • Determined that Alex and his son live in a state where there is a "prudent layperson" law. A prudent layperson law offers the consumer protection by requiring insurance companies to pay for the use of the emergency room if the individual believed he was experiencing a true medical emergency.
  • Filed an written appeal for the denied claim.
  • Educated Alex on alternatives for obtaining after hours medical services for his son.
  • Saved Alex over $500.


A personal advocate lets Steve focus on what matters most - his wife's health

Shortly after becoming a client of Health Champion's Personal Health Care Concierge subscription services, "Steve's" wife was diagnosed with breast cancer. A Health Champion health care concierge (a registered nurse with over 20 years of experience) immediately got involved.

Health Champion:

  • Established communications with the treating physician and his staff.
  • Helped Steve and his wife understand the treatment options available and what was covered under their benefit plan.
  • Assisted Steve and his wife in preparing a comprehensive list of questions for the physician.
  • Scheduled doctors' appointments, ensured that medical communication between specialists and the primary care physician were received in a timely fashion and arranged for second opinions.
  • Arranged to have prescriptions mailed to Steve's home, saving numerous trips to the local pharmacy.
  • Reviewed all Explanation of Benefits related to the care of his wife to ensure appropriate payment by the insurance company.


Natasha gets help while using COBRA coverage

"Natasha", currently on COBRA insurance had trouble refilling her asthma medication at her local pharmacy. The pharmacy told her that they couldn't dispense the medications without full payment because their system indicated her coverage had been cancelled. Luckily, Natasha's parents had been clients of Health Champion and she was familiar with our services.

Natasha called Health Champion from the pharmacy asking for assistance.

Health Champion:

  • Called Natasha's health plan and the COBRA administrator in minutes. Determined that the COBRA administrator had not processed the latest payment. Had the COBRA administrator locate the check and verify to the health plan that Natasha's payment was received and therefore her eligibility should be considered current.
  • Asked the health plan rep to call the pharmacy and resolve the misunderstanding immediately.
  • Enabled Natasha to leave the pharmacy with her medication paying only her copay.


How Health Champion Works with Employers and Businesses

High cost health plan headache

An employer faced with a 25% increase in premium asked Health Champion to assist in the decision on plan design and health insurance carrier for the next year.

Health Champion, in collaboration with the employer's broker, was able to design a two-year medical benefits strategy that would transition the current benefit plan from an upfront hospital deductible plan to a high deductible plan with a health savings account. In addition to benefit design review and consultation, Health Champion provided an in-depth assessment of the medical management and chronic care management capabilities of the carriers highlighting strengths and identifying which carrier's programs would be best suited to deliver reductions in the group's medical expense.

Skyrocketing emergency room use

Health Champion was asked by an employer to review its employees' use of medical services. Health Champion's review identified high frequency use of emergency room services and specialists,but much lower use of primary care services.

Health Champion conducted several benefit sessions for the employees reviewing their benefits and explaining how best to navigate the health care system. Health Champion introduced a customized program for employees that encouraged the appropriate use of the Emergency Room. If the employee could demonstrate to Health Champion that the use of the Emergency room was appropriate the employer rebated the employee half of the copay. This program and the educational sessions provided to the employees resulted in a dramatic 30% decrease in Emergency Room use by employees in one year and a similar increase in primary care visits.