Other Vital Services

Included in our comprehensive offerings are other vital services, which include:

Disease Management

  • A multidisciplinary approach designed to improve patient health, while containing health care costs
  • Focused on helping individuals with chronic conditions such as coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), diabetes, heart failure, hypertension and other chronic conditions
  • Leveraging population health management processes and data to advance a patient’s better health and measure outcomes
  • Applying evidence-based practice guidelines
  • Providing patient education
  • Multi-pronged approach through detailed assessments identifying gaps in care across chronic disease conditions

Disability Management

  • Clinically appropriate disability management to promote a patient’s safe, appropriate return to work
  • Direct communications with the patient/employee, physician, worksite contact and claims payer to facilitate the correct length of disability certification and claims payment
  • Liaison with the treating physician to identify options relating to partial return to work and/or assignment modifications

Hospital Readmission Management

  • Designed to reduce preventable readmissions by effectively addressing the post discharge needs of patients at high risk of readmission including patients discharged post surgically, with congestive heart failure, with chronic obstructive pulmonary disease, and other complex medical conditions
  • Supported by Patient Transition Coaching wherein a Register Nurse Health Coach contacts the recently discharged patient, assesses the patient’s health status, identifies potential problem areas, educates the patient and family regarding the patient’s condition, adherence to the prescribed treatment plan, problems they may encounter and when to contact their physician
  • Available as a standalone program or in conjunction with a Utilization Management or Case Management program

Maternity Management

  • Comprehensive prenatal health and risk management services
  • Thorough health risk assessments conducted at every trimester to identify potential problems
  • Vital patient education
  • Maternity Management Nurse coordination with attending providers and patient
  • Full access to nurse support and Health Information Library 24/7 first three months post delivery
  • Efficient case closure inclusive of post-partum education and depression screening

Medical Claims Review

  • Conducted by experienced Registered Nurses, hospital bill auditors and fee negotiators to facilitate clinically-appropriate and cost-effective claim payments
  • Promoting cost containment with measurable results and prompt turn-around
  • Provided for group and individual health

Network Referrals

  • Ability to refer patients to a primary care provider (PCP) based on several data elements, including but not limited to: gender of provider, where educated, language spoken and office location.
  • Ability to schedule classes or refer to community programs
  • Reduce emergency room visits by assisting patients to access a PCP
  • Access to vital community resources across the continuum of health care including inpatient, acute, residential, rehabilitation, infusion, physical/occupational/behavioral therapies, nutritional, physical fitness, diagnostics/testing, medical aids and durable goods, pharmaceuticals and social services.

In the past few weeks there have been numerous restrictions placed on businesses throughout the United States. Many states and localities across the country have enacted temporary restrictions on non-essential business operations, requiring millions of workers to stay home. Amalgamated Life Insurance Company, which is based in New York, is considered an essential business and therefore is not subject to these temporary restrictions.

However, in an effort to protect the health and safety of our employees, their families and communities, we have taken a series of company-wide actions, across all Amalgamated Family of Companies locations, to implement work from home and other flexible arrangements where feasible. Despite these changes, we will continue to provide you and your members with the customer service levels you have come to expect from us prior to the coronavirus outbreak.

We are diligently working with our partners and vendors to utilize our remote capabilities and infrastructure. We are also in constant communication with UPS and the USPS to stay informed of any potential changes in service. For the duration of this state of emergency, Amalgamated Life Insurance Company will comply with any required Notice Obligations by emailing and/or mailing notices to all consumers.

If you have any questions or concerns please reach out to your Amalgamated Family of Companies representative or our customer service center at: 914-367-5000. They are well-prepared to answer your questions and can address your specific needs.