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What is a "Patient Advocate"?



what is a patient advocate?
what is a patient advocate?

By Martine G. Brousse (not AI!)

"The Medical Bill Whisperer"

Patient Advocate, Certified Mediator

AdvimedPro

 

February 5, 2024

 

  

What is a “patient Advocate”, what do they do and how can they help you?

Let me explain!

 

A.   HOUSEKEEPING FIRST


1.     The dictionary defines an advocate as a defender, supporter, promoter, champion of a cause or person. It is not wrong. Advocates are “helpers”


2.     An advocate meets your needs (financial, legal, clinical), watches over your interests and safeguards your wallet.


3.     However: the term “advocate” has been highjacked by entities who are NOT working for you, NOT promoting your interests, NOT saving you $ and NOT necessarily finding the best solutions. Among those entities are hospitals, insurance companies and TPAs (Third Party administrators.


4.     Ask yourself:

·      Who signs their paycheck?

·      Who holds the authority over their actions?

·      Are they customer service reps or action-based on your behalf?


If the answer is not YOU, then they are probably not your advocate

 

B.    PRIVATE ADVOCATES' ROLES

By contrast, private advocates work only for you.

 

1.     As Navigators:

·      they help you navigate a complex and opaque healthcare system,

·      they find in network providers and specialists

·      they guide you through paperwork: applications for benefits, Power of Attorney, Advanced Directives, etc

·      they locate appropriate facilities for an elderly person, or teen in crisis

·      they handle appointments and help you manage basic medical care

 

2.     As Stewarts:

·      they handle more complex clinical issues

·      they accompany you to appointments or the hospital & discuss treatments with your Drs

·      They supervise your prescriptions and overall medical care

·      They can organize home health services

·      They usually have a medical license or health-related degree (RN, MD etc)

 

3.     As Financial Counselors:

·      they manage accounts and medical bills

·      audits EOBs and statements

·      file appeals on your behalf

·      communicate with providers and insurances re: billing, coverage, benefits and authorization matters

·      they make sure the insurance has paid the maximum per policy

 

C.    Benefits

 

·      Save you time dealing with insurance, finding providers, making appointments, dealing with paperwork

·      Help you get the most appropriate care

·      Offer personal and local oversight and care for someone long-distance

·      Can help determine, manage and implement medical decisions

·      Can save you $ by forcing your insurance to pay the max and providers to abide by State and Federal laws

·      Can save you time, effort and sanity when dealing with financial matters

·      Can help you take the best advantage of your insurance benefits

·      Let you focus on health and recovery

 

D.   What matters

 

1.     Specialties

Just as you would not trust your real estate lawyer with a criminal case, or your dermatologist to order a liver cancer treatment, advocates have specialties or niches. Usually based on expertise, degree, license or past professional experience, those specialties will help address your unique needs and resolve the precise issues you face.

 

2.     Experience

While every case and severity is different, you’ll want to know when a more seasoned expert is required. Previous professional experience, length of time in business and number of similar cases handled successfully are criteria to help base a search on.

A bit of googling, soliciting referrals, and asking questions should lead you to the best advocate, and ensure the best outcome of your problem or concern.

 

E.    Conclusion

A patient advocate is a warrior, your Knight going to war in your name, whether against an insurance company, or against a disease.

 

A patient advocate:

·      Knows your rights

·      Defends your rights

·      Applies your rights

 

So, let us help you!


 

Martine Brousse was a long-time Billing Manager for Physicians before switching to the side of patients in 2013. The move has allowed her to apply her deep expertise and vast experience of the intricacies of resolving all types of medical bill and claim payment issues in ways that directly and positively impact her clientsʻ finances.

 

(424) 999 4705 - F (424) 226 1330

@martine brousse 2024 @ the medical bill whisperer 2024

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