6 Things Your Patient Advocate Wants You to Know

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By: , – By Arianne Cohen, of Woman's Day
3/19/2012 6:00 AM   :  4 comments   :  5,811 Views

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Recognize your needs before you call us.

Some patient advocates specialize in navigating you through the maze of medical bills and insurance; others focus on advising patients through (or even overseeing) treatments for a chronic condition or illness. The trick, says Ken Farbstein, a patient advocate and author of Getting Your Best Health Care, is trying to identify what you need. For support specific to one ailment (e.g., choosing a breast cancer treatment, handling an employer who doesn't understand lupus), contact an association that focuses on that ailment. Many of these groups have free or low-cost patient advocates, often available by phone. To see someone in your home, search the directory at AdvoConnection.com, clicking on the options you need (legal help? bedside care?). Be sure to get references! Prices range from $40 to $200 an hour.
 

If an insurance company won't pay for a treatment, appeal.

"The last thing you should do is pay out of pocket," says Barby Ingle, a patient advocate and executive director of the Power of Pain Foundation, which supports neuropathy patients. "Most insurance companies will deny a first-time or nonstandard service-it's a money-saving tactic, because most patients don't appeal." Fill out an appeal form on the company's website as soon as your claim is denied, and cite sections in your insurance plan that show the treatment qualifies under its benefits and rules. Submit copies of your medical records documenting both the ailment and related treatments you may have tried, as well as a letter from your doctor and copies of any bills. Also include information such as studies showing that the service has worked in similar cases. Follow up weekly.
 

Pharmacists are a great resource.

Not only can they look over your medication lists and help pinpoint any side effects you may be experiencing, but they're also great at referring you to area specialists (they know a lot of them, and can tell you which offices run smoothly), and can give you questions to ask your doctor. Your pharmacist can even sign appeal letters to your insurance company stating that yours is a known and necessary treatment, and list other medications you have unsuccessfully tried.


Click here to read about 3 more things your patient advocate wants you to know!
 


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Have you tried using any of the tips listed above? If so, do you find they help? If not, will you be trying these tips?
 
 
 
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Comments

  • 4
    Appealing an insurance company is much more complicated than this article appears. It is a very lengthy and in some cases impossible process. My insurance has turned down both my GI specialist and my primary doctor for medication I need. They are now breaking their own contract about the exception (that I meet) that they will cover the medication for. Instead, my condition is deteriorating quickly and they're paying out much more because of it.

    Medical insurance companies are most definitely broken and profit greedy. They couldn't care less about the health of the people they insure, no matter how many 'wellness' programs they have.

    I met my deductible in the first 2 weeks of the year and by mid March I've met my out of pocket for the year. I appear pretty healthy (at the cusp of being underweight)and I'm only 30 years, but I have multiple dangerous medical conditions, none of which can be cured and have few treatment options. When they refuse to pay the money to treat one of the simple conditions it makes the others much more dangerous. I can only imagine how long it will be before I have no possiblity of insurance coverage - I have a feeling insurance would rather I die than help keep me alive through all of this.

    As for the article, please be aware that patient advocacy has it's limits, especially when you have multiple conditions. If your doctors can't understand the conditons, no advocate will either. Instead I find it's easier to learn about my own conditions and be my own advocate, constantly fighting for my own life and health. I know more about my body than anyone else ever could and I know more about my conditions than too many doctors, especially how they affect me, personally. It isn't ever easy and it sucks, but I have to believe I'm worth the battle for my life! - 3/21/2012   5:04:28 PM
  • 3
    Wow, I needed this! I'm having trouble navigating the medical system (which is broken in this country), and need help obtaining coverage. Will check out the links. - 3/21/2012   12:42:14 AM
  • 2
    I have a great doctor-- the nurse will call my insurance and fight with them if they deny something :-) Great Article! - 3/19/2012   10:00:40 AM
  • 1
    Great info. - 3/19/2012   6:30:54 AM

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