Using a Patient Advocate to Navigate the Medical Maze

A Patient Advocate proactively guides a patient and their loved ones through the increasingly complex and fragmented health care system.  Patient Advocates educate and empower clients to stand up to doctors, hospitals and insurance companies in defense of their best interests. Advocates work with physicians,  hospital discharge planners, home health care companies, worker’s compensation carriers,  nursing homes, rehabilitation centers and insurance carriers to make sure the patient understands their diagnosis and treatment plan.   An Advocate may go with a patient on doctor’s visits, or file insurance claims on the individual’s behalf.

Locating a true Patient Advocate that has the experience and skills you need is recommended.  Volunteers can be wonderful and the price might be right, but they often don’t have the experience or skills you need to make sure you are getting the best care for yourself or your loved one.  A private Patient Advocate will charge for their services but they are definitely worth the cost, even if it’s only to give you or your loved one the peace of mind knowing the treatment plan is being followed.

You must feel comfortable with an individual In order to effectively use the services they can provide.  It will be important to you to develop a rapport with your chosen Advocate, to have confidence in their abilities, to trust them to collaborate with others involved in your care, and help you understand your options. The following questions should help you in selecting a Patient Advocate that fits your needs.

1.  Have you handled other cases similar to mine before?Advocates that have worked with patients who have similar ailments or are in similar circumstances to yours can be a good indicator of whether you’ll be able to develop a confidence level with a particular Advocate.  You’ll want to determine what advocacy services you need the Advocate to help you with. Some Advocates specialize in helping you understand your diagnosis or treatment recommendations; while others can help you get permission from your insurer for special tests or treatments, or even get your hospital billing straightened out. You’ll want to find an Advocate who has experience performing those services you need. Find out how long the Advocate has been in health care and how long they have been doing this type of work.

2.  What is your educational background?Advocates do not have to be credentialed or licensed but they should have some background in dealing with health care issues and understand how the health care system works.  Some examples of qualified Advocates are gerontologists, nurses and social workers.

3.  What are the charges for your services and do you have a written Agreement?Charges for services will vary according to the types of services needed, the location of the patient (pricing varies across the country, just like it does for anything else) and how much time the Advocate will spend doing the work that needs to be done.  Advocates may charge for doing health assessments, time spent on research, review of bills, handling insurance claims, travel time or even getting tests or treatments approved (overcoming denials) and more.  It is beneficial to have a written Agreement so both parties know what to expect from each other.

4.  Will you have someone else in your office work on my case and if so, is their charge different than yours?Often Advocates have staff that might also work on your case doing phone calls, setting up appointments or dealing with insurance companies.  Typically the hourly cost for someone other than the Patient Advocate is less.

5.  How long will it take to perform the services I need?It is difficult for a Patient Advocate to tell a patient or their family exactly how long the services will take because every patient and situation is different.  The Advocate may only be able to give you an educated estimate until they get involved and see how much is required.  Be clear with the Advocate on your budget-it will help them prioritize what they will be need to accomplish for you.

6.  Are you accepting any new clients?Just because the Advocate can help you, doesn’t mean they have time in their schedule to accommodate your needs especially if you will need them to go to various doctor’s appointments, etc.  Again, make sure the Advocate understands what you need from them before you commit to hiring them.

7.  Do you have references?This is perhaps the most important of all the questions. References are vital. For privacy purposes, the Advocate may be reluctant to provide you with names and contact information. If so, ask the Advocate to provide your name and contact information to other patients who would be willing to speak to the Advocate’s abilities. Make sure you ask the references what types of services they received from the Advocate, how well the services were provided, and whether they would hire the Advocate again if they needed services.

8.  What are your working hours?Many Advocates are available 24/7 to their patients.  If the patient goes into the hospital in the middle of the night it might be necessary for the Advocate or one of their staff to go to the hospital, especially if the patient’s family is not in town.  Some advocacy services such as medical bill reconciliations won’t require 24/7 availability.

9.  Do you provide written reports about the services you have provided?You might not want written reports. But, if you are hiring an Advocate for someone who is out of town (like a child hiring someone to care for an elderly parent who lives elsewhere), then you will want reports. If you are visiting with the Advocate every day, then these types of reports may not be necessary. Also, if there is a charge for the Advocate to produce a report you might decide a report is not necessary.

Once you have decided on an Advocate ask the Advocate to put the answers to these questions in writing or in an Agreement to be sure you both agree on what is expected in the way of services and charges.

Kansas City Home Care has been providing advocacy services 24/7 for over 24 years.  Our knowledgeable and experienced staff will work with you, your family, your insurance carrier and your medical team to make sure you receive the correct treatment of care in a timely and compassionate manner.  For general information about our Patient Advocacy services please call us at 913-325-2681
M-F 8:30 to 5 pm .  If you are in a crisis and need an advocate immediately please call 913-325-2681 for on call staff.

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