What is a Patient Advocate? 

The health care system has changed to the point that it has become too complex for most people.  As patients and their families grow more concerned that they are not getting the care they need, or not getting the benefits of the insurance plan they thought they purchased, they are increasingly turning to Patient Advocates for help.

Why do I need a Patient Advocate?

You would want to hire a patient advocate for any of the following reason, for example:

  • Need help to manage your health care including; assitance with medical appointment to have someone who can help to capture all the information being given in a short period of time, ask the right questions, not have to worry about the medical jargon, and do necessary follow ups such as medication management and necessary tests?
  • Need help for moving from one care setting to another and asistance with screening and identify an appropriate care setting (Hospital. Skilled Nursing, Rehabilitation, Custodial Care, Home Care and Care Giver, etc.).?
  • Need help to select a health plan that meets your medical and financial needs?
  • Need help to manage your health insurance, necessary appeals, billing issues, and understanding your rights to get what you are entitled to according to your policy and the laws?
  • Need help to manage health insurance for your college students, aging parents, and yourself so that you can focus on more important priorities?

Doctors, nurses and other providers experience constraints on their work and abilities that prevent them from being devoted to any one patient’s overall needs. Their time is further limited by the patient’s insurer, level of payment, and attending a large number of patients leaving few patients ever getting everything they need from a provider.

Managing health insurance has become extremely complex. Consumers are restrained from receiving the most and best from their benefits. A Patient Advocate eliminates all unnecessary stress and time spent on these matters and more and more individuals and families are turning to Patient Advocates that have the expertise to do it well.

Clinical providers are employed by a practice, a hospital, or another providing facility. They derive their paychecks from that organization, which in turn is paid only the agreed upon reimbursement from insurance. They are therefore obligated to the payer organization first and their patients second. A private advocate is only obligated to his or her patient.

What does a Patient Advocate do?

An Advocates offers a wide range of services; from accompanying patients to their doctors’ appointments, to sitting by the bedside in the hospital, to reviewing and negotiating medical bills – and everything in between. some of these services are:

  • Helping you to coordinate care between more than one provider or care facility
  • Assisting with the most efficient and hassle free care transition between facilities
  • Guide you to make the most suitable decisions, considering your medical needs and budget, when choosing a health plan and provider
  • Manage your health insurance to give you the freedom to concentrate on what matters most rather than you having to solve the complex puzzle of today’s health insurance
  • Help you to get the most that you are entitled to within the laws and your policy
  • Identify and coordinate benefits you are entitled to with the best available options
  • Help to budget and financially manage your health care cost
  • ​...and much more

Aren’t there patient advocates in hospitals and insurance companies?  

Just as providers have an allegiance to their employer, so do hospital and insurance company advocates. They must dance to the tune of their employer. The one person who can and will focus solely on the patient is a private, independent patient advocate.

How are private advocates different?

You are the employer and the private advocate reports to you as your personal guide with your best interests always on the forefront.

Who pays for the advocates’ services?

Private professional advocates are usually paid directly by the patient or their designee.  A good metaphor is to think of private advocates the way some families regard private education or after-school programs, an attorney, or an accountant.

When a patient faces difficult debilitation, or a life-compromising illness, a private advocate can add value and become very affordable and even necessary.  When a patient or family faces financial devastation from medical bills that are too high, then a private advocate may be financially lifesaving.  When a patient is fearfully facing life and death decisions, the cost of an advocate who can support the patient’s decision-making can help them tremendously. No price can be put on peace of mind.

How many advocates are there across the United States?

An estimate of the numbers of privately paid professional advocates is ~400 or more in the US. Hundreds may be training to become advocates. Still hundreds more are considering advocacy as a career.

As of 2018, there aren’t enough advocates to meet the demand in either the United States or Canada.  The fastest growing regions for the profession are the Bay Area and Southern California, Boston, Washington, DC-Virginia-Maryland, New York City-New Jersey, most cities in Florida, plus Chicago, Phoenix, Tucson, and Seattle.

Are patient advocates licensed or certified in some way?

Yes, a certification exam is being offered by the Patient Advocate Certification Board. Qualified candidates are offered an examination, which if accepted and successfully passed, will be Certified Patient Advocates.  Continuing education courses will be required as of part of the renewal every three years.

How do physicians and nurses feel about private patient advocates?

Most physicians and nurses who have worked with advocates recognize the advantage to their practice.  They spend less time having to re-describe or reiterate their instructions to a patient, knowing the advocate is there to facilitate with the patient.  Instead of spending their appointment time with explanations or long descriptions for patients, they can rely on the advocate to do that work for them. They further know there is an increased possibility of adherence; patients will be more apt to follow agreed upon decisions.

They also feel that given the complexity of today’s health care insurance, these professional can add value by helping the patient better understand and manage information for the patient.

Private Patient Advocate is one of the fastest growing professions of the upcoming decade, and is, indeed, growing rapidly. With Private Patient Advocates this service is available from a professional nurse with extensive experience and knowledge in case management and health care insurance.

Keep exploring and send us your questions. We are happy to answer!

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