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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Got Business? AdvoConnection One Day Business Institute – Reserve Your Spot Now

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Most members of AdvoConnection are aware of the upcoming Business Institute, but for those of you who aren’t members – you are invited, too!

The cost to attend goes up this week, so this is the time to make your commitment.

Topics will include legal, insurance, marketing, tools, money and certification.  Here are some of the questions we will answer:

• Do you have the right insurance at the best price?
• What forms do you need and what makes your contracts legally binding?
• What’s the latest on certification issues?
• How can you deal with business problems your client poses, like not paying his bill, or refusing to sign important paperwork?
• Does your website put your best foot forward?
• What’s the best approach to social media marketing?
• How can you best price your services?
• How should you approach clients about payment?
• What does the IRS expect from you?
• What are some inexpensive ways to reach the right potential clients?
• What other types of services might you be able to offer?
• Who else is out there to help you improve and grow your business?

We’ll have plenty of opportunities for networking, too – including speed dating! (sort of…..)

And – a very special surprise guest will provide our keynote speech.  Join us – because there won’t be a dry eye in the place.

We do hope you can join us!  Thursday, November 3 in Berkeley, CA.

Learn more – and register here:  www.AdvoConnectionConference.com 

(I look forward to meeting you!)

article sponsor: loansonline

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The Option of Saying “NO”

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Several months ago I wrote about the tendency of big-hearted advocates to over-extend themselves with volunteer work; that when someone needs their help, but doesn’t have the means to pay them, they don’t know how to say “no.” We looked at some of the ways to get past that inability in order to keep our businesses moving forward.

Truth is, that is only one of the circumstances where “no” is the right answer.  That’s true whether it is us, as professional advocacy business owners who must choose to say no, or whether we must help our clients choose “no” if it is possibly the right answer for them.

The business “no” is not unusual and will seem very simple once you understand it.

But the client “no” is often overlooked – and you truly owe it to your clients to not only understand it, but to help them understand, and sometimes embrace it, too.

Here’s a business “no” example:

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Insurance Reimbursements? Not Exactly a Pot of Gold

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A recent post from a member advocate in our AdvoConnection Forum asked if any of our members have experience with working with self-funded insurance to offer patient advocacy services.  Wouldn’t that be a great way to establish a big client, with a pot of money that was ready to be paid to private patient advocates?

There were no replies to the question.  That doesn’t mean that no one has experience with these reimbursements. It just means that no one replied to the question.  BUT – the reasons no one replied may be a version of the following:

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Patient Advocacy and the Allegiance Factor

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As we prepare for Private Professional Patient Advocates Week next week, I’ve been asked by a handful of people what the difference is between a private patient advocate and any other health advocate.

It’s an important question, and the answer is actually quite simple.

The difference between a private patient advocate or navigator, and those found in hospitals, through insurance companies, or other places, is what I call The Advocate’s Allegiance Factor.  It’s based on who is producing the paycheck.

Private patient advocates are paid directly by the patient or the patient’s caregiver and have only one allegiance – to the patient.  The patient’s needs, whether they be medical, navigational, financial or locational – are the prime concern of the patient advocate. Period.

However…

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