HealthJoy Services

Health Chat

What is Health Chat?

Health Chat is a service provided by Healthjoy that gives customers an opportunity to chat with a Board Certified Physician whenever they have a medical question or concern. These chats only occur via an online chat and will never be a phone conversation. 

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Health Chat helps guide the customer to the appropriate level of care and avoid longer waits and higher costs at Urgent Care Centers and Emergency Rooms.

Key Points to Health Chat

Uses:

  • A great resource for information on medications, conditions, symptoms, health and wellness
  • Can be used to help triage customers to the appropriate level of care
  • Photos can be uploaded and should be encouraged to improve the triage process (especially for skin issues)

Things to Keep in Mind:

  • It is not an established doctor-patient relationship (Not intended to replace in-person care)
  • Provides no formal diagnosis
  • Physicians will not write prescriptions via Health Chat
  • Not appropriate for those who think they may be experiencing a medical emergency

What Does it Look Like?

As Health Care Concierge (HCC), it is our job to push the customer toward our companies medical services as much as possible. Although Telemed is the preferred option, you may have a customer who:

  • Doesn't have funds to complete  a phone consultation 
  • Has symptoms that are not appropriate for Telemed but they're still seeking medical advice

So in these instances, Health Chat would then become the next best thing to an actual consult. It's important to remember that Health Chat is general medical advice while Telemed is an actual, established, doctor patient relationship. 

Health Chat Quiz 1

  • Appropriate
    General questions about who to go to for health care service
  • Appropriate
    General guidance
  • Inappropriate
    Prescribing Medications
  • Inappropriate
    Emergency situations
  • Inappropriate
    Shortness of Breath
  • Appropriate
    Determining if this extended cough is serious

Health Chat vs Telemedicine

Setting Expectations

When a customer chats to speak with a doctor or Health Chat is offered to a customer, it is important to set the expectation of how the process will go. Because our in-house doctor is not always available, we should chat the customer using the following verbiage. 

This sounds like a question for one of our physicians! Your subscription includes Health Chat, where you can post messages and receive general medical guidance from our team of Board Certified physicians. Simply begin by entering as much information as you would like regarding your medical question.  

As a reminder of our terms of use, Health Chat is strictly for informational purposes and not intended to be used if you believe you could be experiencing an emergency.

Typical response time is within 24 hours or less. 

 

 

If an MD is available: HCC should invite the MD to the chat

If an MD is not available: HCC should create a Health Chat ticket in Oscar (OTRS)

Telemedicine

What is Telemed?

Telemedicine provides patients direct access to consultations by a Board Certified physician via phone.

This can save time and money, and is appropriate for minor medical conditions. The physician can also prescribe medications, as appropriate.

As Health Care Concierge (HCC), it is our job to drive customers to obtain a phone consultation whenever possible. This means that even if a customer did not specifically ask for this service, we should still be offering it for current or future circumstances. 

                                 Pain of Office Visits                                 V  S                     The Convenience of Telemedicine

 

 

 

MeMD

MeMD is a nationwide Telemed provider that has partnered with Healthjoy to provide our customers with a larger network of physicians that are available 24/7 to treat patients. All telemed requests are initiated through Healthjoy's systems then submitted to MeMD for treatment. 

MeMD consults can be completed via phone or video in all states except Arkansas (AR).

U.S. Phone & Video Telemed States (except AR)

How Can It Be Used?

Appropriate Uses

Telemedicine is appropriate for acute (new onset), minor medical problems. Some common conditions that are diagnosed and treated by Telemedicine include: 

  • Allergies
  • Asthma
  • Acne
  • Bacterial Vaginosis
  • Bites and Stings
  • Bronchitis
  • Cough
  • Dehydration
  • Diarrhea
  • Earache
  • Fever
  • Flu
  • Hives
  • Insomnia
  • Lice
  • Medication Refills (not controlled substances or elective medications and only on case by case basis)
  • Migraines
  • Nasal Congestion
  • Nausea
  • Pink Eye
  • Rashes
  • Respiratory Infections
  • Travel Medications
  • UTI
  • Yeast infections

Chronic Condition Treatment

These are medications for long term medical problems such as high cholesterol, diabetes, high blood pressure, etc. This service cannot be used for controlled substances or for elective medications. There is no guarantee that the doctor will prescribe these through Telemedicine. It is completely up to an individual doctors clinical comfort level and the exact situation of the patient. Therefore, in these situations it is best to obtain and explain the following information:

  • What is the exact dose of medication and how it is taken?

  • How long has the customer been on or off of this medication?

  • When was the last time the customer saw a doctor in-person regarding this condition?

  • Why do they need this via telemed? Are they without insurance, etc?

  • Please set expectation with customer that only the doctor can decide if it is safe and appropriate to prescribe the medication.

Inappropriate Uses

  • obtaining work/school release form

  • prescribing controlled substance

    s
    • pain medications

    • stimulants for ADD/ADHD

    • anxiety medications

    • medications to help with sleep

  • prescribing medications for weight loss or sexual dysfunction

  • diagnosing STDs (note: bacterial vaginosis and vaginal yeast infections are not STDs)

  • long term prescription for chronic medications (can be used for some medications for one month supply only. See: Chronic Condition Scripting for example of how to set expectations)

  • prescription of new start of long-term medication (mostly because they need lab monitoring before start)

  • children under the age of 2

  • Treatment of HIV

Some symptoms may represent an emergency and are therefore not appropriate for Telemedicine are: 

  • new onset chest pain

  • new onset shortness of breath

  • change in mental status (confusion, sedation, slurred speech)

  • inability to move a part or body (facial droop, can’t move side of body, etc)

  • any pain or symptom described as a 10/10 severity

  • any symptom in a child <2 years old (should refer to in person pediatrician or UC)

  • suicidal thoughts

Triaging the Customer

Triaging a customer is the process of identifying their symptoms and determining if they are in fact appropriate for Telemedicine. 

Think about those times when you have had to visit an emergency room. The nurse always talks to you first to gauge the severity of the issue and gathers all pertinent information prior to you seeing a doctor. 

Well when it comes to Telemedicine, HCCs are responsible for that triage process. 

Medical Bill Review

What is Medical Bill Review?

Because we are committed to helping customers save money wherever possible, Healthjoy  offers a Concierge service known as Medical Bill Review. 

This service is designed to help customers not only understand their medical bills and charges, but also assist in remedying incorrect charges and/or negotiating bills to a lower amount.

Understanding Charges

When a patient has services done, while insured, they will receive two items in the mail following their visit: An explanation of benefits and an actual medical bill. 

The Process:

  • Review the EOB or Provider Bill for inaccuracies or to help the customer understand the charges. 

If a customer is ever unclear about a charge or feels they were billed in error, our Concierge team should promptly have them send in a copy of whatever it is they are looking at so that we can assess the situation and advise accordingly. 

If an error has occurred then an HCC should reach out to the carrier or the provider, on the customer's behalf, to remedy the situation. 

Explanation of Benefits (EOB)

An EOB is a statement that comes from the insurance carrier and explains the charges that the patient may owe to the provider. It is important to understand that this is not an actual bill and the customer may not necessarily be responsible for the charges listed. 

  • Provider/Services: Lists the name of the provider and the type of service they rendered
  • Dates of service:  Provides the date that the patient had the services done
  • Amount Charged: The amount that the provider billed the insurance company for the service
  • Amount Allowed: The amount determined by a preset schedule of "usual and customary" (UCR) charges. The amount is typically based on the location of provider.
  • Your Copay: The set amount that the insured is responsible for paying to the provider at the time of their visit 
  • Your Co-ins: The cost that the insured shares with the insurance carrier, ONLY after the deductible has been met. There will never be a copay and a coins/ded amount charged for the same service
  • Benefits: The portion of the allowed amount that's eligible for payment by the insurance carrier, minus any copays, deductibles, coinsurance, network discounts and amounts paid by other sources
  • Your Balance: The amount that the patient is responsible for paying, if they have not yet done so already. This can include copays, deductibles, coinsurance, etc. 

Keep in mind that although every EOB is different, the purpose of the statement will not change. 

Medical Bill 

Medical bills are sent by the provider and detail the actual amount owed by the patient, less any payments that have already been made by the insurance company, patient or otherwise. 

Similar to an EOB, a medical bill will indicate the date of service and services rendered along with the details of the charges that were billed, the payments that were made and the remaining balance owed. 

The key difference between an EOB and a medical bill is a medical bill is reflective of an actual balance owed to the provider. 

Negotiating Cost

The process of negotiating medical charges to a lower amount. This is typically available to those with no insurance and is available in most hospitals. 

The Process: 

Contact the billing department of the hospital and ask about their Charity Care benefits. Hospitals will reduce medical bills for those with no insurance by as much as 100%

Claims Management

The process of correcting a claim determination with an insurance carrier. If a carrier incorrectly makes a determination on a claim (i.e. denying a providers claim as out of network, even though they are contracted with the carrier), then the Concierge team is responsible for contacting the carrier to appeal. 

The Process:

HCCs should contact the carrier's appeals department and ask how the appeals process works. 

Medication Cost Review (Optimization)

What is an Optimization?

Medication Optimization is a service offered to customers, which uses a variety of databases to find the lowest prices and best prescription option for a customer based on any given condition.

It is important to keep in mind that this is strictly an optimization and no prescriptions are actually being written, only recommended. 

As Health Care Concierge, it is our role to push this service as much as possible. The Concierge team is only responsible for pushing the service. The medical team actually does the research and makes the appropriate recommendations. This service is useful for those:

  • Who are taking alot of prescriptions
  • Who are without insurance
  • Who are taking tier 2-Tier 4 prescription drugs
  • Who are looking to save money

See example below:

This should only be used for customers who are interested in the full service. For example, it is possible that the optimized medication recommended is a different medication than that which was originally prescribed.

If the customer has an URGENT need or is not open to changing medications, then an Rx optimization would not be the most appropriate option., is not needed. The Concierge can search simply search for prescription discounts within Healthjoy's prescription search tool. 

What information is needed?

In order for our Medical team to complete an optimization, there are a few key pieces of information that will need to be gathered (see below). 

In addition to fields below, the Concierge team should also ensure the customer's insurance plan has been confirmed. This is very important because the Medical team cannot confirm the insurance cost if the plan has not been confirmed. 

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Prescription Discounts (Rx)

If a customer is in need of some general discounts and is not interested in a Medication Cost Review, the Concierge team can simply offer to locate the customer discounts on their prescription medications. 

Discounts available do vary based on location and campaign partnership.

When attempting to locate a discount, there a variety of places that an HCC can check: 

  • Manufacturer's website-For coupons
  • Healthjoy's prescription parternship websites (UNA/Goodrx)
  • Call pharmacy directly 
  • Prescription help programs (primarily for those with a chronic conditions such as diabetes or HIV)

To communicate discounts found, HCCs can either chat the customer using the following template or simply communicate the information verbally. 

You may be asking, "Why is current cost important?" 

Well this information is important because it helps us determine if we have actually saved the customer any money.