For people navigating an often confusing healthcare system, such as Colorado caregivers often do, one source of help in some circumstances may come from a patient advocate. These are professionals who help patients and caregivers tackle the complexities of today’s healthcare system, allowing families to offload some of the bureaucracy stress and instead focus on the day-to-day demands of caring. While those needing care usually rely on spouses, family members or friends to support them, both mentally and practically, having an informed person by your side who already knows how the system works and who is knowledgeable, assertive and steady can make a huge difference.
Things Patient Advocates Do
The services offered by patient advocates can vary but typically include the following:
• Help find the right health provider based on the patient’s needs and financial resources.
• Set up medical appointments, take patients to visits and make sure they follow their medical care schedule.
• Assist clients through the phases of diagnosis and treatments, just like a family caregiver would do. Ask questions of the medical staff and make sure all the patient’s concerns are addressed.
• Translate medical terms for clients to help them make informed decisions.
• Handle the maze of insurance, co-payments deductibles, etc. Help choose the best health plans, review billings, negotiate denials of claims and other discrepancies.
• Help seek legal assistance in the case of medical errors, malpractice, and such.
• Advise clients on wellness and lifestyle choices to help them recover from a disease and/or improve their health.
• Collaborate with all the professionals involved in a person’s care.
Where to Find Patient Advocates and How to Choose One
The online information/education source Verywell Health (VH) states quite frankly that finding a competent and reliable patient advocate takes effort, especially finding one who has the experience and skills you need. “Volunteers can be wonderful,” VH explains, “and the price may be right, but they often don’t have the experience you need to be sure you’re getting the best care you can get.” So VH says your best bet may be locating a private patient advocate. They charge a fee for their services, but VH says “they are definitely worth the cost, even if it’s only for the confidence you will have about getting the best care.”
VH offers a website — AdvoConnection — with a searchable directory of advocates who offer a variety of the kinds of help patients and caregivers need, such as medical, hospital bedside assistance, insurance denials or claims, billing reviews and more. You can search for an advocate by the location of the patient and the service you need. There is no charge to use the site.
Another free-to-use website offers a list of advocates who belong to an organization called NAHAC, the National Association of Health Advocacy Consultants.
If you do an online search on the phrase “Colorado patient advocates,” you will find a number of sources, including the UCHealth System and various Veterans Administration centers in the state.
How Coloradans Should Evaluate Patient Advocates
Engaging a patient advocate is obviously a critical step that requires care and what is typically called due diligence. Once you have found one or more names and contact information for prospective advocates, you should contact each of them to get a sense of whether or not they can help you, what the process will entail, and how much their services will cost. There are no standard fees or standard procedures because every client and situation is unique.
Nonetheless, says Verywell Health, your prospective advocates should be able to give you satisfactory answers to the following questions.
Have You Handled Cases like the one I have before?
An advocate’s previous experience working with clients with similar health conditions, or in similar circumstances to yours, will be a good indicator of whether you’ll be able to feel confident. You want to be able to develop a rapport with your advocate, to trust them to collaborate with others involved in your care situation, and help you understand your options.
What are your credentials?
You want to find an advocate who has experience performing the services you need. Some advocates, for example, specialize in helping you understand your diagnosis or treatment recommendations, while others can help you get permission from your insurer for special tests or treatments, or even get your hospital billing straightened out. A certification from the Patient Advocate Certification Board has been available since March of 2018. Documented patient advocacy training is considered a key plus for advocates to have. Other relevant background for an advocate to have is an associate degree or a bachelor’s degree in the medical domain. An advocate who knows how healthcare systems work, including understanding diagnoses and treatments, are other pluses. It is known that employers who hire patient advocates look for them to have training or experience in nursing, health-related programs, social work, social science, and medical billing. It is common to see professionals with previous experience like this switching to become patient advocates.
What are your fees?
Charges for services will vary according to the types of services you need, the location of the patient (pricing varies across the country), and how much time the advocate will spend doing the work that needs to be done. Advocates may charge for doing health assessments, time spent on research, review of bills, handling insurance claims or even getting tests or treatments approved (or overcoming denials), and more. Fees are not standardized, and patient advocate costs are generally not covered by private or government health insurance (at least not for services limited to “patient advocacy” per se.)
How long will it take you to perform the needed services?
Especially if the advocate charges by the hour, you’ll need an idea of how long a service will take to perform. You are likely to get a range of hours and a range of total costs.
Do you have time to handle the workload?
Even the most competent advocate will not be a good fit if they do not have time in their schedule to accommodate your needed services. Obviously this would be particularly relevant if you need someone to stay with your loved one overnight, which not all advocates can do. Another question might be whether the advocate can be on call 24/7, if unexpected service is needed (e.g., an urgent trip to a doctor is needed.) Keep in mind that for either of these contingencies, where the advocate is located would be a factor to consider.
Do you provide written reports on the services you render?
This may or may not be necessary. If you are with your loved one continuously and are aware of the services given, you may not need reports. The same may be true if you visit with the advocate on a daily basis. Note there could also be a separate fee for providing written reports, which could affect your decision.
Can you provide references?
This is potentially the most important of all the interview questions. For privacy purposes, however, the advocate may be reluctant to provide you with names and contact information of current or past clients. This is understandable. An alternative might be that you allow the advocate to provide your name and contact information to other clients of the advocate who would be willing to speak with you about their advocate’s abilities. You would not have to divulge your own circumstances but just hear how these other clients rated the quality of the advocate’s services and the overall client-advocate relationship. If the reference is willing to say, ask what types of services the advocate provided and whether they would hire them again if they needed advocate services.
VH advises that once you’ve made your choice for an advocate, ask them to put the answers to your interview questions in writing. You would also be wise to have a signed contract with the advocate to be sure you mutually understand and agree on what is expected, such as specific services to be provided, scheduling of services, the advocate’s availability, their fees, and any contingencies you think need to be accounted for upfront in case they might arise.