Service
Year-round advocacy
The part everyone else stops doing on January 16
About Year-round advocacy
Coverage problems do not respect the enrollment calendar. We handle life changes, appeals and renewals for the whole plan year.
Open Enrollment is eleven weeks long. Coverage problems last twelve months. Most of this industry treats January 16 as the end of the year, which is precisely when the interesting problems start.
Life events and Special Enrollment
Moving counties, leaving a job, turning 26, a birth, a marriage. Each opens a sixty-day window and each requires specific documentation. Losing coverage uniquely opens the window sixty days before the loss, which means you can enrol in advance and avoid a gap, but only if someone tells you that in time.
Denied claims and prior authorisation
A denial is not a verdict. Internal appeals have deadlines and formats, and external review by an independent body is available in every state once internal appeals are exhausted. A meaningful share of appealed denials are overturned, and most denials are never appealed at all because the letter is written to discourage it.
Network departures
Carriers drop hospitals and physician groups mid-year, sometimes with very short notice. Depending on the circumstances that can trigger continuity-of-care protections or, in some cases, a Special Enrollment Period. We watch for the announcements rather than waiting for you to find out at a reception desk.
Renewal, which is a decision and not a default
Auto-renewal is how people end up on a plan whose deductible rose by $1,400, whose network dropped their specialist, or whose premium rose while the benchmark fell so the credit shrank at the same time. Every autumn we re-run your file against the new filings and tell you plainly whether staying is the right call.
How it runs
Watch the calendar for you
Renewal review every autumn, mid-year income check-in, and a standing note of any deadline attached to your file.
File Special Enrollment properly
The right event, the right date, the right document, filed inside the window rather than argued about afterwards.
Appeal what should be appealed
Internal appeal, then external review if needed, with the deadlines tracked rather than discovered late.
Flag network changes early
Carrier network announcements monitored against the providers you told us matter.
Questions about this specifically
Does year-round support cost extra?
No. Broker commission is paid per member per month for as long as you hold the policy, which means the incentive is already aligned with keeping your coverage working rather than with selling it once.
How likely is an appeal to succeed?
It depends entirely on the reason for the denial. Coding errors and missing prior authorisations are frequently resolved on the first internal appeal. Medical necessity disputes are harder and are where external review matters most.
What if I want to move to a different broker?
You can change or remove a designated broker at any time and it does not affect your coverage or your price. We would rather you did that than stayed on a file you were unhappy with.
More general questions are answered on the questions page, and the vocabulary is on theglossary.