CareCounsel - Healthcare Advocacy

Advocating for You and With You. Navigating the complex world of health benefits can be a challenge, leaving you questioning if you have made the right choices for you and your family’s best health. CareCounsel’s health advocacy program is a special benefit sponsored by the County that can help you understand and effectively navigate your health benefits.  We offer high touch and customized service backed by experience and depth.  We have provided assistance to thousands of employees since 1997 and look forward to helping you when you need it.

Here are just a few of the things CareCounsel can help you with:

• Choosing a health plan during Annual Enrollment
• Benefits education and assistance for all types of health plans (medical, dental, etc.)
• Getting the most of your healthcare dollars
• Helping you find physicians and get care
• Obtaining second opinions
• Troubleshooting medical claims/bills   
• Grievances and appeals
• Navigating Medicare (when you turn 65 and ongoing)
• Access to the Stanford Health Library
• Stanford educational webinars and community education sessions
• Connecting you with expert healthcare resources
• Becoming a proactive health consumer

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.

Customer Service

CareCounsel representatives are available 8:30 a.m. to 5:00 p.m. Monday - Friday at  (888) 227-3334.

Additional information can be found on CareCounsel's website.

Open Enrollment Support

Making Choices for Tomorrow

• Educate about 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
• Help with navigating on-line enrollment systems
• Locate network doctors, hospitals and ancillary services in new plan
• 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
• Find health coverage for out-of-area family members

Benefits Education and Troubleshooting 

Maximizing Healthcare Dollars

• Educate about healthcare benefits, coverage, terms and concepts
• Explain cost advantages of using network providers
• Help get plan approval for non-network providers when services not available through network providers
• Promote wellness programs, EAP’s, health risk appraisal programs and other health management programs offered by health plan or employer
• Obtain referrals and authorizations for required services
• Coordinate benefits with spouse’s plan or between health and ancillary health vendors
• Troubleshoot pharmacy issues including tiered Rx benefits and mail order
• Support with appeals and grievances

Doctors & Hospitals 

Finding and Getting Care

• Find doctors, hospitals and ancillary services using health plan’s on-line tools
• Confirm provider network status and scope of practice
• Provide quality and outcomes data to help decision-making
• Help arrange appointments and transportation when needed
• 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

Clinical Advocacy 

Becoming a Pro-Active Healthcare Consumer

• Access to a medical librarian for personalized research about a disease or health condition using Stanford Health Library’s proprietary databases
• Arrange second opinions
• Review disease-related educational materials with a registered nurse
• Help participants understand treatments, tests and procedures recommended by their doctors
• Learn about clinical trials, medication/prescription subsidy programs and community-based support groups
• Locate physicians, hospitals, quality data, centers of excellence and home healthcare
• Prepare for doctor visits and surgeries with checklist of questions to ask
• Engage participants in under-utilized health plan resources: disease management, wellness and clinical decision support tools
• Help address quality of care concerns and provide appeals and grievance advice

Claims Assistance 

Troubleshooting Medical Bills

• Educate about claims process and understanding explanations of benefits
• Advocate for employee to correct claims errors (deductibles, copays, application of network discounts, UCR’s and COB)
• Negotiate out-of-network provider fees or non-covered charges
• Retroactive audit of bills and statements
• Coordinate with health plans, medical groups, doctor’s offices, hospitals and ancillary providers to resolve billing disputes and inappropriate balance billing
• Work with provider offices to resolve claims submission and coding errors
• Help with claims denials and appeals
• Troubleshoot issues with collections agencies 

Retiree Support 

Medicare and More

• Educate about Medicare and how it interacts with employer-sponsored health plans
• Assist with eligibility and enrollment process
• Give guidance to common healthcare considerations facing retirees and pre-retirees
• Help arrange appointments and transportation when needed
• Troubleshoot coordination of benefits with Medicare
• Help understand formulary, tiered Rx benefits and mail order
• Provide information on community services for social and financial support
• Locate nursing homes and long term care options 

Healthcare Resources 

Expert Help when Your People Need It Most

• CareCounsel Tip Sheets on a broad range of healthcare topics
• Disease and condition-related information and support groups
• National and local advocacy groups
• Prescription subsidy programs
• Low-cost transportation options
• Individual health plan options
• Publicly-funded insurance options
• Reputable and unbiased Internet health resources