I’ve just returned from Florida, having spent almost two weeks with my sisters, taking care of details since Dad died. There were plenty of tears – of course. But even more laughter – because despite our mourning, we shared many marvelous family memories as we uncovered this treasure (good grief – our grade school report cards!) or that one (did we really wear our hair like that in the 80s?)
And of course, there were the conversations with the more than 100 people who attended Dad’s memorial service. (Quite surprising really – they were mostly in their 80s and 90s.) It was a memorial service like few others – exactly what he requested – a celebration – a party! …including an open bar and hors d’oeuvres afterwards. The readings and passages were part-mournful, but more than that, they were an homage to a man loved and respected by many. My sisters and I were so very proud of the man who was our father.
Included in the celebration service was music, of course. But not what you might expect. Instead we put on a Glenn Miller CD, and a mix of other music from the 1940s. In the Mood, Candy, Boogie Woogie Bugle Boy — Dad would have loved it. I know his friends did.
The music – it was an important part of Dad’s life – and his death. In fact, through his final few days, I asked his hospice nurse to turn on the TV cable channel that plays1940s music – because it brought him so much pleasure to listen to the songs he shared with Mom as they were dating, fell in love and married. It seemed to work well, taking his mind off his pain, as he finally relaxed, slept, and then passed. Continue Reading →
Something I’ve noticed over the past two years or so is that people who write to me for help seem to be getting increasingly belligerent when they don’t like the information I share, or reply to their questions or requests.
A woman wrote to me through my About.com Patient Empowerment site, asking me to please make a phone call to her psychiatrist to tell him that she needed a higher dose of Xanax. I replied to her to say that first, I don’t work directly with patients – I write and speak and run an organization. Further, that I would never consider phoning someone’s doctor to tell them what to do! Further, that I don’t deal with mental health issues at all – I just don’t have any sort of knowledge bank that could help me do that. I was polite, I suggested she make a list of reasons to share with her psychiatrist that might help him help her, etc. She wrote back…
You get a phone call from a prospective client who would like to talk to you about possibly helping her out. The story may vary, but the bottom line is that she is stuck and needs help from someone who can help her manage some aspect of the healthcare system. She thinks you might be that person.
As part of your marketing, you happen to offer a free consultation, which maybe takes place right then and there on the phone, or maybe you make an appointment to meet with the potential client… Or perhaps you simply have a conversation whether it’s considered a free consultation or not….
An in-depth conversation takes place. This potential client has a dozen questions about her situation, and to the best of your ability, to showcase your capabilities, you answer her questions. You feel great about the conversation because you know you’re impressing her with your abilities.
At some point the potential client says, “Thank you. You’ve given me a lot to think about. I’ll call you again if I decide I need your services further.” And you both hang up.
You’re stunned. You feel as if everything went so well… you were able to answer her questions, you referred her to some good resources… yet – she didn’t hire you. Where did you go wrong? What should you have done differently?
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.
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.