[sidebar]But who helps when you need medical services and can’t navigate the stacks of insurance paperwork? A patient advocate, of course! A relatively new breed of service provider in the health care industry, patient advocates help remove roadblocks between you and the medical care you need. Having problems negotiating an insurance claim? Can’t access the out-of-network specialist you need? Not sure what your diagnosis means? “Our experience is that people reach out to us when they feel they don’t have any other resources that can solve this problem for them,” says Nancy Davenport-Ennis, founder of the nonprofit Patient Advocate Foundation, in Newport News, VA. More than 6.4 million Americans contacted PAF for information or help last year, according to Davenport-Ennis. Of that group, almost 40,000 needed help to receive much-needed medical attention and coverage. [pagebreak]
When you need the facts
Patient advocates also can serve as educators, helping to explain a confusing medical diagnosis or treatment plan. “For a lot of people, it takes work to be that informed on a medical condition and to get the best treatment,” says Ed Hampson, RN, a senior personal-health advocate with Pennsylvania-based Health Advocate, Inc. “There’s a lot of information online, but when it comes to specific diseases and issues of medical nature, we help patients understand it.”
When dealing with insurance hassles
Even when you have medical coverage, taking care of the bills can be overwhelming. “We help both insured and uninsured people in the United States,” says Davenport-Ennis, “and 80% of the people who reach out to us for help are insured.” From negotiating preauthorizations for medication and therapy to appealing billing disputes, it is tough for anyone—especially someone in poor health—to jump through all the necessary hoops to get treatment. More from Prevention: Care For Caregivers
When you want to know your options
You know that thick book your HMO gave you on the details of your policy? Few people have the time—or patience—to read that cover to cover, but an advocate can review this document with you to uncover the information you need to get the most out of your health plan. Jason McNichol, PhD, founder and director of Health Advocacy Solutions LLC in Oregon, explains a case in which a client came to him with a life-threatening illness. The client wanted a second opinion and the option to try a treatment plan that his HMO said it wouldn’t cover. “We first went through the policy very carefully and identified exactly what the circumstances would be under which he would be allowed a second opinion, and what his doctor would need to do in order to get the treatment plan covered,” McNichol says. [pagebreak]
Where to turn for help
Many hospitals and insurance companies have on-staff advocates who can help arrange postsurgical discharge plans, schedule follow-up appointments, and plan transportation to and from doctors’ appointments. Ultimately, however, they represent the interests of the hospital or insurance company for whom they work, not the patient. But you can enlist an advocate to work on your behalf. Your employer may provide patient-advocacy services in your benefits package. Free services offered by nonprofit groups such as Patient Advocate Foundation and condition-specific organizations such as the American Diabetes Organization may also be helpful. For-fee services can quickly mediate your issues, but before you sign on, make sure to get a cost estimate. McNichol notes that his company charges about $100 per hour and often can resolve issues in just a few hours, saving clients both money and time. When researching a patient-advocate service, make sure the case workers are experienced registered nurses, qualified medical professionals, or have a background in social work. “Really, we’re just doing the homework and providing the additional research and backup support to help the patient make things happen,” McNichol says. To find a patient advocate in your area, visit Patient Advocate Foundation, or ask your doctor for a recommendation. More from Prevention: 14 Health Mistakes Smart Women Make
