September 24, 2020
Healthcare is a maze. No matter where you live or what you do for a living, it is hard to navigate.
A new field called Professional Patient Advocacy or Health Advocacy has quickly risen as a solution to guide patients and their family members through the complexities of the healthcare system. These health advocates know the ins and outs of the healthcare system due to training and lived experiences. It's common that they worked in the healthcare industry, including nursing, medicine, pharmacy, or insurance backgrounds.
Those in health advocacy sort out concerns or questions related to healthcare so that patients can navigate the system with ease and get the care they deserve. Those who practice advocacy, often called Professional Patient Advocates, work with patients to represent their best interests when patients are faced with a challenge.
Professional patient advocates often hold the board certification and/or are associated with national health advocacy groups and organizations to further their knowledge. They are referred to as patient navigators, too.
Every patient will have different healthcare needs. Patient advocates can help patients communicate with their healthcare providers, set up and prepare for appointments with doctors and nurses, as well as arrange financial, legal, and social support. Their role often involves working with insurance companies, employers, case managers, lawyers, social workers, and others who may play a role in a patient’s healthcare needs.
A patient advocate offers many different types of services, but they will focus on a patient's specific situation when working alongside them. Examples of patient advocacy include:
Researching and explaining diagnosis and treatment options, translating any medical speak to common English
Reviewing and negotiating hospital medical bills, so that all charges reflect the patient care received
Preparing questions when meeting with a doctor, nurse, or specialist to get the necessary information to make informed decisions
Services provided by patient advocates can span many areas, like care coordination, medical bills, health insurance, and legal administration:
Generate and explore treatment options
Arrange second opinions
Find clinical trials
Improve communication with doctors & nurses
Help prepare for appointments and attend appointments
Organize advance care directives, hospice and palliative care
Estimate, plan for, and reduce costs of care
File and track bills and paperwork
Review medical bills for errors
Dispute denied claims for hospital bills or other medical billing
Find personalized financial resources
Suggest new health insurance plans, including Medicare and Medicaid
Handle paperwork and insurance filing
Find in-network healthcare providers for patient care
Arrange gap extensions for out-of-network care
Appeal rejected health insurance claims
Assist with worker’s compensation
File and review disability claims, including Social Security Disability
Arrange guardianship or conservatorship services
Mediate disputes with hospital or medical facilities
The need for advocates has continued to grow as the cost of care increases and the healthcare system becomes more challenging to navigate. The value offered by advocates is very specific depending on the case, but most often, it involves one of the following three themes:
1. They provide peace of mind to out-of-state family members
It can be challenging to play an active role in the care of other family members when living in a different city. For family members who live far from one another, hiring a patient advocate can bring peace of mind to the entire family, knowing that the health of their loved one is taken care of. An advocate can still be in a different state than the patient, but can have more oversight of the patient’s situation by virtually accompanying them to their medical appointments, managing their medical records, and ensuring that all family members have a full understanding of the diagnosis and treatment plan.
2. They reduce the financial burden of healthcare
Many medical bills contain errors. Advocates can help avoid overpaying by spotting mistakes, determining the best insurance policies, researching financial resources, and reducing any out-of-pocket costs with tips and tricks.
3. They make sure patients have all the information needed
It is very easy to become overwhelmed with the amount of information provided by medical teams. An advocate can help make sense of things you might be unfamiliar with or have difficulty understanding. They can explain a diagnosis, treatment options, and the medications being prescribed.
There is never a bad time to hire an advocate. People find it especially helpful when they want:
More engagement in their care (ie. better outcomes and treatment options)
To get credible and trustworthy information
To eliminate medical errors
To sort out medical bills and avoid medical debt
Improved communication with their doctor, nurses, and specialists
It's common for hospitals, insurance companies and the VA to offer advocates for patients. Good patient advocates can be found that way, but unfortunately, that advocate might not necessarily want what is best for the patient. Someone who has set up their own independent practice is more likely to advocate for patients in the right way, without any ties to an employer (ie. the hospital or insurance company). They can be resourceful, though, if your questions are related to the specific medical facility or insurance policy.
Private patient advocate costs can vary on a few factors, the types of services needed, the advocate's credentials and experiences, and the patient's location. Costs are typically set on an hourly basis and start at around $125 per hour.
They can be! Many people explore careers in nursing because they strongly believe in advocating for patients' rights and want to go the extra mile. That explains why some professional advocates have nursing degrees and work experience.
Any advocate is a person who represents another person's best interests. The word "advocate" comes from a Latin word, advocare, which means to add a voice.
Well, you've come to the right place.
Everyone is patient at one point in their lives. As a patient, we want to identify and evaluate the risks and benefits of patient care options, we hope to manage costs and avoid medical debt, and we want a clear understanding of our condition and treatment for confident decision-making.
A good patient advocate helps patients achieve exactly that.
At Caribou, we're helping this incredible profession reach - and ultimately help - more people by building a place where you can connect with professionals who practice patient advocacy everyday, no matter where you live. You're no longer required to connect with an advocate in the same city or geography as you. Our national network of Healthcare Advisors are thoroughly vetted, so that you can rest assured that anyone you connect with is fit to help you find solutions to your health care challenge.
Caribou's Healthcare Advisors are a trusted group of superheroes who are ready to advocate for patients and generate options to tough healthcare problems. Get started today by speaking with a Healthcare Advisor about your healthcare concerns or goals at no charge.