Human support for the health care moments that count
See how UnitedHealthcare WholePath Advocacy solutions combine compassionate experts and data to simplify care experiences and support better outcomes.
- Confusion about coverage remains a common challenge. 36% of consumers said they felt unsure about what their insurance would cover.1
- Personalized advocacy can help connect people to support sooner. UnitedHealthcare WholePath Advocacy solutions report 94% post-call satisfaction and an 84% program referral acceptance rate.2
- Complex needs often call for more connected care. Members with complex needs may have 7 times more medical spend and 3 times as many medical claims.3
- Human-led advocacy can help improve the benefits experience for employees and employers. By combining compassionate experts, data-driven insights and digital tools, UnitedHealthcare WholePath Advocacy solutions are designed to help employees feel supported in moments that matter while helping employers improve satisfaction, outcomes and cost performance.
Employees may have access to strong benefits and still face challenges understanding what’s covered, where to go for care or how to resolve claims and billing questions. That uncertainty can add stress at moments when people need clear answers most. In fact, 36% of consumers felt unsure about what their insurance would cover, pointing to the need for simpler guidance and more personalized support.1 Without that, employees may delay care, choose care that does not fit their needs or miss programs and resources already available to them.
That’s where advocacy can make a meaningful difference, combining human connection with tools and insights that help simplify the experience.
At UnitedHealthcare, every member has access to trained, compassionate Advocates who can step in and step up wherever they are in their health care journey. UnitedHealthcare WholePath Advocacy solutions bring together medical, specialty, pharmacy, behavioral health and clinical resources to help address an individual’s whole-person health needs in real time or even proactively, rather than treating each issue or question episodically.
The personalized and proactive support that UnitedHealthcare Advocates provide can turn challenging or stressful situations into meaningful moments that drive more satisfying health care experiences, better health outcomes and lower costs for employers and employees.
Advocacy in action: Support after an unexpected bill
After treatment for early-stage breast cancer, Sarah, a UnitedHealthcare member, received an unexpected bill she didn’t understand and called a UnitedHealthcare Advocate for support. The Advocate discovered the radiology provider had billed Sarah inaccurately and helped lower Sarah’s final bill.
“I was grateful to have health insurance distilled down to an interaction between me and another human being who really cared about me receiving the help that I needed,” said Sarah.
Enabling smarter, more proactive navigation
94%
post-call member satisfaction2
In a complex health system, connected information can help create clearer paths forward. UnitedHealthcare brings together people, data, digital tools and AI to help make each member interaction more informed, whether that starts online through the UnitedHealthcare® app or by phone with an Advocate.
This includes anticipating and flagging potential health risks and needs based on a member’s claims activity or patterns identified through similar claims histories. It can also include working behind the scenes to assist Advocates with real-time information and transcriptions, allowing them to focus on their conversations and provide more relevant, timely and accurate support to members.
For example, WholePath Advocacy uses an omni-channel approach, consisting of emails, texts and calls, to reach out to members at key points in their health care journey. Outreach may be triggered by specific events, such as when an out-of-network provider performs an eligibility check, a member approaches a therapy benefit limit or receives a prior authorization denial (for those with Enhanced Advocacy models). These timely touchpoints can help members better understand their options, avoid cost surprises and enroll in relevant care management or clinical programs when appropriate.
84%
acceptance rate of program referrals2
Sarah’s experience shows how that connected support can make a confusing health care moment feel more manageable. After receiving an unexpected bill, she called a UnitedHealthcare Advocate who helped investigate what happened. “I was grateful that I was being treated as a human being,” Sarah said.
Whether a member starts a chat with Avery, the AI companion available through the UnitedHealthcare® app or myuhc.com®, or calls an Advocate directly, the experience is designed to feel seamless. If Avery identifies that a member may need additional support, the conversation can be routed with relevant context, helping reduce the need for members to repeat their story and allowing Advocates to pick up where the interaction left off.
During chats or calls with members, Advocates are also assisted by their own version of Avery that helps listen to and understand member questions and surfaces relevant information in the moment. Access to timely data and intelligent recommendations is helping make these conversations more meaningful and efficient so that members walk away understanding their next-best actions.
The result is not just faster interactions but also more informed, personal experiences that can help employees and their families feel supported and satisfied with their benefits.
Leading with compassion and expertise
What makes interactions with Advocates especially meaningful to members is knowing there is someone who cares and seeks to understand their unique situation and needs. That’s because health care is deeply personal. When someone is managing a new diagnosis, recovering from a hospital stay, caring for a child with special needs or trying to make sense of a complex condition, members need more than a quick answer. They need trained experts who can listen, build trust and help support them with care and compassion.
“Advocacy is about meeting members in moments that can feel complex, stressful or uncertain,” says Rebecca Madsen, chief executive officer of Advocacy for UnitedHealthcare Employer & Individual. “By combining compassionate support with the right tools and insights, we can help Advocates support members with the information and resources they need.”
“Because of the Diagnostic Odyssey program, I now have a much better handle on everything as a whole and how to go about taking care of myself better. It's a game changer and I am so thankful for it.”
- Amber, a UnitedHealthcare member who received support via the Diagnostic Odyssey program
That is why UnitedHealthcare Advocates are more than customer service representatives. They are champions for members, helping them feel heard, understood and supported as individuals. Depending on their needs, members may be connected with specialized Advocates, including:
- Benefits Advocates, who provide plan and coverage expertise
- Health Advocates, who provide claims expertise
- Nurse Advocates, who provide health and clinical education, decision support and expertise as licensed registered nurses (RNs)
- Pharmacy Specialists, who provide end-to-end service related to pharmacy benefits, including formulary support, lower-cost alternative recommendations, home delivery and claims and benefits management
- Mental Well-being Specialists, who provide expertise on behavioral health provider selection, benefits explanation and the sensitive handling of mental health needs
Up to 2-4%
in medical cost savings for employers with Enhanced Advocacy models4
Access to a multidisciplinary team of experts who can look across a member’s benefits becomes even more critical when employees or covered dependents are facing more complex needs, which tend to require more touchpoints across the health system and more opportunities for confusion, delays or missed support. In fact, these members have 7 times the medical spend and 3 times as many medical claims.3 That’s where Super Advocates, for those in Enhanced Advocacy models, can provide more focused support and help with long-term escalations for those navigating more complex health issues.
Dedicated Care Advisors, who are available across all Advocacy models, can also make a meaningful difference for these employees and families. Through programs like Special Needs Initiative (SNI), Diagnostic Odyssey and Complex Care Concierge (C3), Care Advisors serve as a consistent single point of contact for members or their dependents to help coordinate care, remove barriers and support more personalized, high-touch health needs.
The value of Advocacy
For employers, that kind of support can help create a benefits experience that feels more human. When employees feel their health plan sees and supports them as individuals, it can also shape how they feel about the employer who made that support available. And for employers who invest in Enhanced Advocacy solutions, that experience may help drive higher plan satisfaction, improved health outcomes, lower costs and greater insights to help more actively support employees on their path to better health.
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