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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