What to do?  What to do?   The Health Exchange Marketplace has opened.  The Health Reform Act is so confusing.  

Here is a link to Frequently Asked Questions that may be of help to you:

http://kff.org/health-reform/faq/health-reform-frequently-asked-questions/?utm_source=Autumn+2013+&utm_campaign=Autumn+2013+Special+Edition&utm_medium=email

How can a Patient Advocate Help Me?

Ella is a sweet woman who was widowed several years ago. She is exhausted. She has diabetes, arthritis, kidney failure and heart failure. Her Primary Care physician thinks her Cardiologist is following her health. Her cardiologist believes the Heart Failure Team is doing the job. The Heart Failure Clinic assumes her Primary Care Physician is her lifeline. Ella’s medication list is long and complicated. She was due for a pacemaker check a month ago and needs current blood work analyzed. Ella was always a high energy woman who needed no help and accomplished a tremendous amount, but today, she doesn’t have the energy to organize and follow through with the important aspects of her healthcare.

You would think that when you are diagnosed with a serious condition, your doctors would coordinate and oversee your care. In the real world, though, doctors are frequently double-or triple-booked, and they simply may not have time to communicate with your other treating physicians or explain the nuances of all your medications. As a result, it is often up to you, the patient, to push for time-sensitive treatments, locate specialists, or research clinical trials. Then there’s the non-heal-related but equally crucial legwork: fighting insurance denials or early hospital discharges, all while being treated for what may be the most significant health issue of your life.

That’s where professional patient advocates – who handle everything from nabbing an appointment with a busy specialist to haggling with insurance companies – come in. This service is particularly important with the changing state of healthcare in America. Ella’s advocate was able to organize and coordinate all of her schedules and appointments, including getting a denied medication approved by providing the insurance company with documentation about possible adverse side effects with the insurance-covered substitute.

What does a "Patient Advocate" do? The simple answer is that they help people navigate the healthcare system. A Patient Advocate acts as a support structure, and if legally contracted to do so, may act as a liaison between a patient and their Health Care Provider and/or Insurance Company. The Patient Advocate does not compete with your healthcare provider, they offer assistance where the role of physician becomes limited. A Patient Advocate can help alleviate the pain and the frustration that goes with the worry of uncertainty, fear, and the unknown related to health care issues.

Do you need a Patient Advocate? Consider hiring an advocate if:

· You have several medical conditions to follow.

· You are unable to think clearly. Some people are in shock following a diagnosis. Some medications impact the patient’s comprehension and concentration, and some conditions are complicated to understand.

· You have been diagnosed with a progressive or degenerative illness.

· You have a chronic illness that requires follow up care.

· You have medical bills that you don’t completely understand or have the time or energy to deal with. Each provider bills separately, even within the hospital, and there is a high percentage of bills with errors.

An advocate can be a medical bill detective.

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Just what exactly is a Patient Advocate?

Everyone knows suffering. Often, when we are the most wounded, and we need help the most, we don’t know where to get it. Navigating the dizzying medical-care maze can be both time-consuming and confusing.

This is where a Patient Advocate comes in. What does a "Patient Advocate" do? The simple answer is that they help people navigate the healthcare system. A Patient Advocate acts as a support structure, and if legally contracted to do so, may act as a liaison between a patient and their Health Care Provider and/or Insurance Company. The Patient Advocate does not compete with your healthcare provider, they offer assistance where the role of physician becomes limited. A Patient Advocate can help alleviate the pain and the frustration that goes with the worry of uncertainty, fear, and the unknown related to health care issues.

The state of healthcare in the United States means that we may no longer be able to count on healthcare professionals such as doctors, nurse practitioners, physician assistants and nurses to provide all the care we need. It is not their fault. They are being pulled in too many directions by health insurance companies, pharmaceutical companies, and vast amounts of medical research they can't keep up with.

The Healthcare system is changing dramatically. There are thousands of pages to read to keep up with the changes. To add to the complexity, each insurance plan and each insurance company have different contracts and rules for individual policies. Each insurance company has a different contract and payment schedule with individual hospitals and providers. It is easy to see how we find ourselves in a maze that is difficult if not impossible to navigate. The addition of long waits and runarounds add to this frustration.

Patient Advocates aim to facilitate the relationship between individuals and their health care, from helping locate the best doctors and specialists, to researching treatment options and assisting with insurance claims and appeals.

Legal assistance is sometimes warranted, but it is not necessary to pay large attorney fees for basic advocate care. Patient advocates are not attorneys. If you do need legal counsel, they can help you find competent and compassionate counsel after doing all they can do, and we will provide them with all the information that has been compiled and gathered in your behalf. Your medical information is held in utmost confidentiality and security.

The need for Patient Advocacy relates to people of all ages and life styles. It doesn’t discriminate.