Healthy Resources

How Your Health Insurance Company Helps You Stay Well

By Jarett Bies, Avera Health

When it comes to staying healthy, resources are everywhere. Ones you can trust might be closer than you think.

“Health plan members expect more than just affordable premiums and benefits coverage. Our members are very savvy and they’re looking at factors beyond deductibles and copays,” said Jordan Anderson, vice president of sales with Avera Health Plans and DAKOTACARE. “Costs are a consideration, true. But people are looking at how their insurance company can help them achieve well-being goals. It’s an expectation – and one that can provide both the health plan and the member with benefits.” incentives and value-added aspects within their coverage plans are often healthier. Companies providing that coverage receive the advantages that come with members in good health. In many cases, education, reminders and customer service support can help anyone stay ahead of the game in terms of health.

“We see preventive, no-cost services, which are required under the Affordable Care Act, as one of the keys to stopping what we call the ‘smoldering ember’ effect in a person’s health,” said Anderson. “A smoldering ember, if not noticed, can lead to a roaring fire. Preventive screenings, checkups and immunizations can stamp out those potential health issues before they grow unchecked and lead to substantial problems.”

Health insurance companies offer more than just a policy. They often offer expertise and a big-picture approach toward health that makes a difference. For example, Avera Health Plans has Personal Health Services which includes health coaching, discounts to fitness facilities and help with managing a chronic disease or complex illness. Focusing on a member’s holistic health, personal health outreach helps people with issues that can affect their health. They may be issues that have nothing to do with health care, for example, living environment or lifestyle patterns.

Insurance company teams are vigilant, using online and telephone-based communication to remind covered members about checkups and other services that are timesensitive or scheduled. Customer-service professionals, as well as physicians, health coaches, pharmacists and nurses, make sure covered members are aware of their care.

“Our member health advocates get involved on many levels, such as when they can catch members before they are referred to out-of-network providers. They will see if an in-network provider could provide the service they need. That involvement can save members a lot of out-of-pocket cost,” said Cari Haug, RN, a Case Manager with Avera Health Plans Personal Health Services. “Our advocates also are an excellent resource for members who seek community resources, and they are well-versed on benefits. They answer coverage questions as well.”

Vigorous research and data evaluation can also help companies to be preemptive and support their members when it comes to prevention and well-being.

“We evaluate a tremendous amount of data as well as being thoughtful around the social determinants of health to make sure people are getting the proactive communication they need in order to ensure the right care occurs at the proper time,” said Anderson. “In cases where people were recently diagnosed with chronic conditions, we might be the first outreach they make after speaking with their doctor. In that moment, we are prepared to provide the insight they need to adjust their lifestyle and best deal with the illness they face.”

Thoroughness is only one way that a health insurance company can provide well-being and better health solutions. Convenience is another apt consideration.

“Employers realize that by offering at-work health events such as biometric screenings or flu-shot clinics, they are helping employees and their pocket books by making wellbeing easier,” Anderson said. “We encourage every member to talk to either their employer or to call customer service so they can take preemptive steps, know their options and utilize all the services that come with their coverage.”

Contact your insurance carrier to see what benefits are included in your plan to help you stay well. n

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