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Going it alone is NEVER the best choice when it comes to health care. Especially if you have time-sensitive treatments, a complicated diagnosis, or insurance issues to consider. When you need someone on your side — supporting your well-being, getting medical appointments, managing treatments plans or fighting for your benefit rights — you need a health advocate.

A relatively new response to today’s complicated health care system, health advocacy is considered a critical service by CNN and other news sources. Knowing when to hire an advocate, and how to choose one that’s right for you, is key to a successful outcome.

What’s the Problem?

Define your needs before looking for someone to help resolve issues. For example:

  • Do you need someone to oversee care being provided to yourself or a loved one?
  • Are your needs related to developing a plan of care for a particular diagnosis?
  • Is it an insurance issue? Are your benefits being denied?
  • Do you need help researching the latest technologies and treatments for a disease?
  • Are you worried about mom and dad living alone?
  • Will you need the advocate to be onsite at a hospital or facility?

Locating a Private Advocate

An internet search, using the key words “health care advocate” will direct you to   advocate websites. Review their areas of expertise; narrow your choices and examine how their services meet your defined needs. Ask for referrals from friends, family members and physicians (use the terminology “case manager”).

Consider the  Fit

Like physicians and health problems, advocates come in all shapes and sizes. Some have a “take charge” style” others are more laid back. Finding the right fit is critical. Things to consider:

  • Have they helped clients with similar issues?
  • If so, what do they consider a successful outcome?
  • How many client cases do they work on at the same time?
  • Do they have a resource network?
  • How easily can you reach them during the week? Off hours?  Holidays?
  • How do they keep clients apprised of progress?
  • How does the advocate charge for services: hourly or set rate?

Health advocacy is typically private pay, with fees ranging from $100 – $200/hour. The right advocate will guide you through the health care maze and so that you get the benefits and treatments you need when you need them. And that’s priceless.

There are times when you know it’s an emergency and you’re off to the ER. You don’t fool around with chest pains, for instance (no taking chances that it’s just indigestion). Ditto for broken bones and deep cuts.

But what about those other times? You know them: the sense that something’s  wrong, but you’re not sure how bad it really is. it always seems to happen over a weekend or during the evening, when the doctor’s office is closed. Waiting doesn’t feel right, but neither does rushing to the emergency room.

Call your doctor. Most physicians have an answering service for this purpose. Offer the following:

  • Your full name; that you’re a current patient, in active treatment.
  • The best way to reach you (provide both cell number and land line).
  • The reason for your call, emphasizing that, while it doesn’t seem like an emergency, it’s a matter of serious concern that can’t wait for office hours. Don’t be too explicit, as most folks who take messages have little clinical experience. Use phrases, such as:
    • My new medication is making me ill
    • I am experiencing several new symptoms
    • My pain has increased over the last (number of) hours and I need to discuss a different approach
  • Find out who’s on call. Ask the service to contact the doctor on your behalf rather than waiting for him/her to call in for messages. Note the time of your call and ask to be called back after the service relays your concerns. This will give you a time frame and help relieve anxiety.

Don’t ever hesitate to seek help.  Even over a weekend. Even when you’re not sure whether or not it’s an emergency.

You’re a WHAT? And you do WHAT?”

It’s a typical a response from physicians who haven’t scanned the forest of health care lately to see there’s a new animal in their midst. That animal goes by the general name of “health care advocate” and the specific name of Health Champion. Our general nature is to help, guide and support individuals lost in the maze of decisions, diagnosis and insurance benefits.

Here’s an example —

The Call:  We were recently retained by a family to help navigate their sister’s s journey through multiple myeloma. They called as she was recovering from surgery, having experienced the disease’s wrath in the form of bony metastases.

The Need:  On a very basic level, they were seeking clarity about their sister’s condition, needing a greater understanding from the surgeon and oncologist regarding  prognosis and overall treatment plan.

The Approach: We quickly established contact with their sister’s  medical providers, providing each office with signed HIPAA and Representative forms, so that physicians could speak freely with us. The goal was to collect information from the various sources and then connect the dots for our client, explaining complicated information in a clear, accessible manner.

The Result: Our client and her family felt fully informed and, thereby, empowered to make smart decisions regarding the recommended treatment plan.

The Response:  Because we’re newcomers, medical colleagues are often surprised by our presence. Who are we . . .where did we come from . . . what’s our intention? But, seeing that we come in peace, they’re collaborative, professional and open to the concept of advocacy. And then there are those few defensive physicians, wary of our intentions, certain our goal is to undermine and undercut, to add an unneeded layer to an already complex system. That is so not so!

They’re right about one thing: The health care system is definitely layered and complex. It’s fragmented, confusing and overwhelming. It isn’t easy being a physician in today’s insurance-based model. And it’s not easy being a patient or consumer. That’s exactly why we exist.

Our role is to support our clients and their health care team by closing gaps in communication and planning, by explaining and reinforcing the difficult messages they have may have been told, but didn’t understand, and were too embarrassed to ask for clarification.

While health care reform may be upon us, it isn’t going to fix the very things that health care advocates are hired to do. We’re on the scene, and we’re here to stay.