The Health Advocate’s Olympics

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Like many of you, I have been glued to the Olympics for more than a week.  I stay up very late every night (and have to drag myself out of bed in the morning!) to watch athletes who can twist or turn or propel their bodies in ways that seem practically inhuman.  A mix of awe, pride, respect and, when it comes to Chinese badminton players, incredulity.

Watching the athletes and the competitions, I realized there are some metaphorical similarities between what they do, and what we, the pioneers of the profession of private health advocacy, are working to accomplish, as follows:

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What Health Advocates Need to Know about the Affordable Care Act

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It’s official and it’s not going away.

The Patient Protection and Affordable Care Act, also known as healthcare reform, or the ACA, is changing the face of healthcare for every American. The first changes became effective shortly after its passage in 2010.  New parts of the law will continue to be implemented until January 1, 2014 when the biggest part of the law, the individual mandate, will ensure (almost) ever American has some form of insurance or government coverage to pay for the care they need.

Are you, as an independent health advocate, prepared for those changes? Even further, are you prepared to help your clients and potential clients understand them?

Here’s why it’s important you become familiar with the new ACA law – not just for yourself, but for your practice, too:

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How Health Advocates Can Save Money for Their Clients

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Over the past few years, increasingly, I hear from patients who (usually after hospitalization) feel that they have been unfairly billed for medical services.They contact me because they find an article or two I’ve written at my Patient Empowerment site at About.com about medical billing and insurance.

When I say increasingly, I mean – since the first of this year the numbers have really spiked.  I mean, really spiked. As if the medical billing universe has decided that no one should get a correct bill anymore, and everyone should be required to pay for something they didn’t think they should pay for.

Now – I don’t have the ability to help people get their bills corrected when there really are mistakes.  I leave that to the professionals (and yes, of course, I refer almost all those folks who contact me to engage with a billing specialist listed at AdvoConnection.)

However, there are a few general troubleshooting ideas I have for them, like:

  • Since insurers seem to change their in-network list of providers on a whim, you must always check to be sure the doctor you’re about to see is still considered in-network (even if he or she has always been in-network before.)
  • Likewise with insurance formularies – co-pays, in particular for newly developed drugs, seem to change overnight. Many Tier 3 drugs are now Tier 4 (which, to me, means, let’s just throw out a huge number and charge the patient!) and patients are blindsided by the increased cost.
  • Yes, it’s possible your insurance covers most of your hospital stay, but that the anesthesiologist does not accept your insurance – you’ll have to negotiate payment with those who don’t accept your insurance.
  • The Affordable Care Act (healthcare reform) does have a list of preventive tests you no longer pay co-pays for, but that doesn’t mean the doctor won’t recommend a test or a drug that will not be covered as “free.” You need to check the list.
  • Balance billing is illegal in most states, yet it happens every day. If you think you have been balance billed, then use that term when you call the doctor’s billing department.  If they don’t back off the bill, then ask them to explain why it ISN”T a balance bill.  And if the answer is not satisfactory, then tell them you plan to report them to CMS. Maybe they’ll change their minds.

Things like that.

So what does this have to do with being a health advocate?

If you are a billing advocate, this is probably your bread and butter – the work you do on behalf of your clients every day.  Thank you for that!

But if you another flavor of health advocate, say medical-navigational, then the fact that so many billing problems are occurring, with increasing frequency, provides an opportunity for you to make a real difference for your clients – because you can be the person with the yellow flag.  It’s entirely possible that you can save your client enough money to pay for your services – or more.

The key is to provide your client with that “inside information” that medical bills rarely turn out to look like a client expects they will – so what you would like to do on their behalf is to double check all pricing before services are actually delivered.

(Of course, that will be mostly impossible in an emergency situation, but should work just fine in most other situations.)

I would even go so far as to say, that not checking pricing ahead of time could create problems for them – AND you – because if they end up being blindsided on a bill based on something you recommended, and the bill is correct, it will reflect on you – and your client won’t be happy.

I’ve put together a list of good practices, ideas and “how to” links you can use to save money for your clients.

AdvoConnection members: find this list by logging in to your membership dashboard, finding the Client Services Center, then Client Relations. Look for NEW!

Not a member? You can access this list, too – and much more.  Join us!

• • • • • • LEARN MORE • • • • • •

FOR PATIENTS | FOR ADVOCATES | FOR POTENTIAL ADVOCATES

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How Empowering Your Clients Makes You a Better, and Stronger, Health Advocate

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Those of you who know me beyond my work with AdvoConnection may know that my roots – the reason I started AdvoConnection – came from patient empowerment – specifically the recognition that when we are sick and debilitated, or scared or worried, most of us are unable to process the information we need to assess in order to make the wisest choices for ourselves.

I experienced it myself, and I’ve heard stories over and over again – where the illness and emotion just don’t allow for even the most intelligent, rational thinkers to conduct themselves the way they would in any other aspect of their lives. From the very human reaction to illness of wishing Mom was there to take care of us, to the ingrained-from-an-early-age attitude that “the doctor is smarter than I am, the doctor is always right, the doctor knows what’s best, the doctor knows everything there is to know….”  — the natural default is to yield discussion and decision-making to the doctor.  But doing so can wreak havoc on our health.

Most recently the subject has popped up in the AdvoConnection Forum – based on an article in the New York Times called Afraid to Speak Up at the Doctor’s Office.  The point being that as patients, with difficult symptoms, a new diagnosis, or ensuing problems, are afraid of asking questions that make us appear as “difficult” patients.  As a result, we don’t get the information we need, we aren’t empowered to make the right decisions for ourselves, and we are therefore simply defaulting to what’s being expected of us – not making smart, rational choices.

It’s what I call the “If I Ask Too Many Questions, the Waiter Will Spit In My Soup” fear. Except in this case, it can be life and death.

The discussion in the AC Forum is very much about this phenomenon as the basis for needing an advocate by one’s side in the doctor’s office.  And to that I say a loud “Amen!” Discussing with a potential client this fear of discussion with the doctor can certainly help him or her decide that you are exactly the right person to help them out – as if you have read their minds and truly understand them.

But I also see a broader picture – one that can not only help your clients improve their experiences, but can move your health advocacy practice forward, too. 

The truth is, much of what our clients need is confidence:  confidence for holding up their side of a conversation with (even intimidating) providers, confidence to leave a provider who just isn’t doing right by them, confidence to make the decisions they know need to be made – and more.

You can be the person who helps them build that confidence, and as such, you will build their trust and appreciation for the work you do with them.  For many clients (and potential clients) you will not only strengthen their abilities to manage their own medical situation, but you will expand the work they rely on you to do.  And when they tell others about how you helped them, it will be in glowing terms (great marketing!)

I’ve written up a list of possible ways this can be done – a springboard for your own ideas as well.  Improving client confidence will make you a better advocate, and will help you grow your practice, too.

AdvoConnection members can find this list by logging in to their membership dashboard, finding the Client Services Center, then Client Relations. Look for NEW!

Not a member?  Join us!

 

• • • • • • LEARN MORE • • • • • •

FOR PATIENTS | FOR ADVOCATES | FOR POTENTIAL ADVOCATES

• • • • • • • • • • • •

 

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Client Discussions: Where Do Spirituality and Religion Come In?

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My travels over the past two weeks have ultimately taken me to Florida where I’ll be staying for awhile to spend time with my dad.  It’s the latest in many, many visits, which I mention only because that means I have gotten to know many of Dad’s friends over the years, too. In fact, I’ve gotten to know a handful of them very well, so that I actually seek them out once I get here to be sure I have the opportunity to spend some time with them.

One such friend is a gentleman I’ll call Jim, who lives next door to Dad. A retired lawyer, Jim has now become a Eucharistic Minister who calls on many sick people and leads services on a Sunday morning.  He is well-respected and admired by so many, a man who balances his sense of fairness with his religion and spirituality. He puts a great deal of effort into making sure that anyone who would like to attend his services, regardless of their religious affiliation, is welcome to do so.

The three of us enjoyed brunch together today, and as it frequently does, the conversation turned to how life experiences were affected by our spirituality, the meshing (or repelling) of religion and politics, other people’s experiences as seen through a spiritual lens, and more…. Since Dad and Jim both live in a senior transitional-type community, where friends are often undergoing medical treatment, and where too many friends pass away, some of the discussion centered on healthcare and spirituality.

Midway through this morning’s conversation I realized (duh!) that perhaps spirituality is a topic advocates should be addressing with their clients. Considering the tendency of most human beings, whether or not they are religious (part of a specific religion), to turn to prayer and pastoral support when they are faced with a health crisis (their own, or a loved one’s), it seems that at least discussing spiritual needs with clients could be useful in at least three ways: Continue Reading →

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