Apple Basics
This is a specific piece of information we should ask about right at the start of the call to make sure our callers feel comfortable, safe and seen
Pronouns
Alicia received preventative care from her doctor--this is how much she should expect to pay
Zero
A wellness visit can turn into this type of visit if the Member brings up a new medical problem during the exam
Diagnostic
Prior authorization
This benefit offers 25 free therapy or coaching sessions per year for employees and dependents
Lyra
These are the four major carriers Apple members may have
UHC, Aetna, Kaiser, HMSA
This type of account rolls over forever and can be paired with eligible high-deductible coverage
HSA
Whoops--Pam thought she had out-of-network coverage, but she got a huge bill because of this
Balance billing
For Saver Plan members using Transcarent Surgery Care, Apple covers 100% of the procedure costs once this is met
This virtual pediatric and young adult behavioral health service supports ages 1–25; coaching is no cost, while therapy and medication management may have limited cost
Bend Health
This is an Apple cultural "non-negotiable" that should shape every interaction--it's why we verify HIPAA!
Privacy
This type of account is generally "use it or lose it," though Apple allows $660 to carry over
FSA
Jimmy was unpleasantly surprised that he didn't get a physical ID card--that's okay, you can just send him here for a digital one
Carrier website
If an Apple member has an active Leave & Time Away case, this is the vendor they need to speak with
Sedgwick
This family-building path covers elective freezing up to $35,000
The BRA
This is where complex claims advocacy and appeals should be directed
This type of plan has a handsome $1700 individual in-network deductible that must be met before receiving coverage
Saver HDHP
Muriel is getting her claims denied because the carrier thinks she has more than one insurance plan, so she needs to go through this process
Coordination of benefits
For out-of-network providers, this person is responsible for making sure services are eligible before they are rendered
The Member
This expert second-opinion service is available at no cost to Apple employees and even their extended family members
Teladoc
New Apple leave or time-away cases should be sent here, not Sedgwick
People Support
Optum will only approve prior authorization for GLP-1s when the prescription comes from this source--otherwise, dig deep into your pockets
A 9am Clinician
When helping with a claim, the carrier will often ask for this provider-specific identification number, so you better be prepared
NPI
This rule determines the primary plan for a child whose parents both have coverage
Birthday rule
A Member expresses a concern that her doctor is not culturally sensitive when it comes to Black health--this company can help
Included Health