More about New York Life Group Benefit Solutions (NYL GBS) Health Advocacy Services? Senior care and special needs services The Personal Health Advocate may assist with senior care and special needs services to locate: •Eldercare facilities, group homes, nursing homes, adult day care, etc. •Homemakers, home health aides, private duty nurses, rehabilitation services. •Physicians who make house calls for people who cannot easily get to the doctor’s office. •Autism spectrum disorder-related in-home, school- and community-based services, treatment centers, day camps and ASD-friendly doctors, dentists, hair dressers, etc. •Find the right doctors and specialists and schedule appointments. •Answer questions about their insurance plan, test results, treatments and medications. Administrative support services – benefits and claims NYL GBS Health Advocacy Services also includes assistance with medical, dental and vision benefit claims. The Personal Health Advocate may: •Provide information and assistance regarding benefits, coverage, eligibility, claims and related paperwork. •Assist with preauthorization and predetermination process. •Assist with transition from out-of-network to in-network providers. •Help with eligibility, denials, and incorrectly applied provider coding deductibles and co-pays. •Help resolve incorrect plan procedure interpretations, such as emergency room claims denied for a lack of pre- certification. •Help resolve questions about whether services are condition-specific or related to preventive care. •Help resolve coordination of benefits disputes between multiple carriers. •Help obtain referrals for required services. •Locate in-network suppliers and obtaining plan approval for the use of out-of-network suppliers for necessary healthcare equipment and supplies that are not available from in-network suppliers. •Help customers understand the process for obtaining coverage for medical equipment, devices, supplies (e.g., hearing aids, diabetic supplies, compression stockings, etc.). •Help customers through the review and appeals process, including if necessary filing grievances, gathering supporting documentation, writing appeal letters and participating with the customer during a conference or review. This service does not include legal advice or representation, which only an attorney can provide. Financial support services NYL GBS Health Advocacy Services also helps customers to get the most out of their health care benefits. Personal Health Advocates may: •Counsel customers regarding current benefit costs and the cost of alternative approaches. •Provide comparative cost estimates for the service in question. •Negotiate fees with healthcare providers prior to services to lower the customer’s out-of-pocket costs. •Review questionable bills to catch duplicate or erroneous charges. •Provide zip-code based cost estimates for common medical services and procedures. •Conduct initial investigation of medical bills to ascertain the customer’s true out-of-pocket responsibility for the remaining balance. Page 23 | Duncan Supply Company, Inc.| Plan Year 2025 Open Enrollment This booklet provides only a summary of your benefits. All services described within are subject to the definitions, limitations, and exclusions set forth in each insurance carrier or provider’s contract.