Quantcast

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.

A co-worker recently shared this story: “My mother is 84 and incredibly robust. Ever since I can remember, she’s had this one refrain: ‘If you have your health you have everything.’ Growing up, I figured this was merely a sentiment, designed to distract me from wanting all the material things they couldn’t afford. In fact, I couldn’t really internalize the value of that statement until I hit my 40’s (ah, the joys of middle age!). Now I get it.”

Listen closely to people edging toward the other side of middle age, or those challenged by illness or disability, and you’ll see a shift in values; they’re talking more about the state of their health than the status of their portfolio. They understand that things are just things. But if you have your health, you have everything.

As health care advocates, we’re reminded daily of how important our health truly is. In fact, it’s our greatest asset. Take care of it like you would your life savings: Invest in it. Manage it. Pay attention to it. Like your nest egg, once it’s gone, it’s not easily replaced.

As we look ahead to 2010, we hope the year brings you the blessings of good health. Happy New Year.

Imagine this: You’re visiting your parents — maybe for the holidays — maybe it’s a casual, routine visit . . . and you suddenly realize there are a lot of medicines around the house. The first fear that comes to your mind is: how is this being managed and what about drug interactions?

It’s scary stuff. And it’s exactly what happened to a client of ours.

Medication errors are among the most common medical errors, harming at least 15 million people every year. More than one-third of the errors that occur in the U.S. happen in people 65 years of age or older. And, the more medicines a person takes, the higher the risk of having an adverse reaction from a drug interaction

So, what can you do to help your parents manage their meds without actually being there to dole them out?  The answer is education and advocacy. Partner with them and have a clear understanding of what they’re taking and why.

Here are some hints:

  • Help organize their medicines; look at every bottle for the date it was dispensed. A good rule of thumb: don’t keep any medication longer than one year. Generally, if it’s that old, it’s no longer being used.
  • Look for the same medicine in several bottles. Check the strength. Some people take different strengths of a medicine at different times of the day.
  • Ask for permission to speak with doctors on their behalf.
  • When they’re given a new prescription, make sure they ask if it’s in addition to ones they’re already taking, or a replacement med. If there’s any confusion, you should call the doctor directly.
  • Call each doctor’s office and ask what drugs are being prescribed. Be clear that you want only the meds prescribed by that doctor, not just a repeat of an old drug list.
  • Create a comprehensive list of all meds being taken and keep it updated. Their pharmacist is an excellent resource for this task, especially if your folks tend to use a single pharmacy. Make sure each doctor has that list, checking for possible interactions.
  • Your parents should keep a copy of the current drug list in their wallet, in case of emergencies. For tech savvy parents, they should keep the list in the PDAs.
  • Don’t go it alone, especially if you live in different states. Enlist the help of a health care expert to guide you and your parents through the maze of prescriptions drugs.

Finally folks are turning to generic drugs as a way to reduce their overall prescription drug costs. If you have concerns about the questions about  generic drugs check out the following article.

http://www.nytimes.com/2009/12/19/health/19patient.html

“Why won’t my insurance cover a CT Scan of my heart that the doctor says I need.”

That was the call we received recently from a woman who was confused, upset, and uncertain about getting the care she needed.  She’d had questionable results from both her stress test and her cardiologist recommended that she follow up with a CT scan ( to be exact, her doc wanted a CT scan of her coronary arteries, affectionately known as code 0146T).

But her insurance company refused to authorize this critical test.

Why?  Was there anything we could do to help?

We went right to work and here’s what we discovered:

  • The cardiologist’s office followed protocol by calling the woman’s health plan and submitting the required information. However, what was submitted didn’t meet her insurance guidelines.
  • We obtained a copy of the company’s guidelines for radiology, and then compared the information sent by the doctor.
  • We then interviewed the woman and discovered she’d neglected to mention certain symptoms to her doctor.
  • We discussed those symptoms with the doctor’s office; they updated the information, sent it off for insurance review, and the test was authorized.

Lessons learned…

  • Always ask why. If you need a test/procedure and your health plan won’t authorize it, ask for clarification. You’re entitled to a copy of the guidelines used to make the decision.
  • Don’t assume that your doctor’s office will engage with the health plan on your behalf. Stay on top of the situation.
  • Review the information and symptoms you’ve shared with your doctor and see if there’s more that might be helpful.
  • If you’re having trouble getting answers, enlist help. Don’t just settle for “no.”
  • Realize that by enlisting a private advocate, you save time and money and get results.

Whether you’re trying to get through the health care maze on your own, or need to engage the services of a health advocacy group, such as Health Champion, one thing is certain: you need unbiased, credible, up-to-date information. That’s what you’ll find here.

Through this blog, our goal is to help you become an empowered health-care consumer. And, because we’re a private advocacy company — without ties to government or insurance companies — beholden to no one — you can count on us to be in your corner. We commit ourselves to honesty and integrity. We’ll share what we know, offer our opinions, help you find answers, and give you information you won’t easily find elsewhere.

Over the past few years, there has been a growing need for health advocacy, giving people somewhere to turn . . . someone who will support and promote their rights within the health care system. Health Champion is answering that call.

We’re a young company with passion and experience; all of our established health care professionals are dedicated to helping people navigate today’s complex system, finding the answers they need when they need them. We work with individuals and families on a variety of levels, privately or through their employer.

We’re excited about starting this blog, a natural extension of our commitment and outreach to health care consumers. Look for a new post every Wednesday, where we’ll write about everything from health care reform to making wise medical choices to getting the most from your benefit plan. Be prepared for topics such as Ten Stupid Things in Health Care Today, Shopping for Colonoscopies, and What Reform Will Mean to You.

We welcome your comments and look forward to a lively exchange in the months ahead