Open Enrollment Made Easy: Navigating Benefits with Donald Tice

Open enrollment is always a busy time for HR professionals, and it is a time when insurance navigators are needed most. By helping employees answer questions and select the right healthcare plan, these specialists allow HR to focus on other strategic initiatives. And our insurance experts, known as Clinical Associates, do just that. In this blog series, we’ll meet some of Eden Health’s Clinical Associates and hear why they love helping patients navigate their benefits. 

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Overview | Describe your role in a tweet.

The insurance navigation team works our hardest to save Eden patients as much money as possible on insurance out-of-pocket costs and specialist fees.


Details | How do you help employees save money during open enrollment? 

I help patients find the best plan that suits their medical needs while also keeping their financial situation in mind. I try my hardest to give them the best options based on what their employers offer and what they need in terms of care. By gaining a holistic understanding of their specific circumstances, I can guide them to make a decision that is right for them.  


COVID-19 | How has the pandemic changed the work you do?

COVID has really changed a lot of workflows for us and a lot of office visits for patients, since they try to avoid coming in if they don’t have to. We've also been fielding a lot of questions as to what their insurance covers in terms of telemedicine or teletherapy.


Value | What value do you provide to the employee? 

Health insurance and the healthcare industry are super complex, even for people who have been doing it for a long time, like the insurance specialists on our team. So being able to provide patients with clear answers that not only save them money and time but also give them the best access to medical care, I think is really important.


HR | How do you help HR managers? 

By being there to answer employee questions, I alleviate some of the burden for HR from a specific question standpoint. If HR people themselves ever have a question, whether it be about our own providers or insurance issues, I do the best I can in the shortest amount of time possible to get them the answers they need.


Work highlights | What do you love most about your job?

I love finding ways to save a patient money on out of pocket payments, whether it’s a copay or deductible. Saving them the money that they're entitled to is always super rewarding.

Take one patient I was helping this week. They went to a specialist, and the specialist’s office incorrectly coded a bill, which in turn caused the patient to pay a higher amount than they should have. So once we looked into it and reconciled it, the patient wound up with a $50 refund from this doctor's office. And even though to some of us $50 may not seem like a ton of money, for many people right now $50 can make a difference in being able to get groceries that month or pay the rent. So the patient was super grateful and we were very humbled at how much of an impact $50 made for them. 

I felt great. It really made my day. 


Find resources for open enrollment and learn more about our Clinical Associates in Navigating the Benefits Maze, Eden Health’s free guide to benefits navigation.

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