What’s In a Name? A Caveat for “Navigators”

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Friend of health and patient advocates and NAVIGATORs everywhere, Elisabeth Russell, forwarded a link to many of us this week – an article from the National Cancer Institute regarding the use of patient navigators for cancer patients.

My first reaction is – what a marvelous, MARVELOUS service these navigators are providing to cancer patients.  I have to wonder how cancer patients ever survived treatment prior to having a navigator to help them!

And then I have to pause….

I see a few problems cropping up – two that can be problematic for health and patient advocates, and one a problem for patients.

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When Potential Clients Won’t Buy the Milk

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Does this sound familiar?

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?

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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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“Ask a Health Advocate” Makes Its Debut

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All patients and caregivers have questions for health advocates. Just like they have questions for their doctors, or nurses (or the Internet!), they have questions about navigating the craziness of the healthcare system, or questions about their medical records (or rights to get copies), or about a claim that won’t be paid, or a bill that is higher than they expected, or explanations of treatment options – many many questions that need answers.

Sometimes the only way to sort out their challenges is to hire someone to help – thus AdvoConnection’s Directory to help them.

But sometimes what they have are general questions that don’t require a contract or handholding so much as they require a quick suggestion or a piece of advice.

Or – sometimes there is no advocate who lives in their proximity.  Or – sometimes they really just can’t afford a health advocate to help.

Enter a new online service that can not only help these patients and caregivers, but can help independent, professional, private patient advocates market their services, too.  It’s called Ask a Health Advocate.

Simply explained:  a patient or caregiver submits a question. It gets posted to the Ask a Health Advocate website. AdvoConnection members answer it, and the answers are published along with the questions they answered.

Everybody wins – and everybody is better informed than they were before.

Take a look at the new Ask a Health Advocate site.  If you are a member of AdvoConnection, take a stab at an answer.  (There are a few rules and guidelines.)

(And if you aren’t a member?  Join us!)

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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!

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