When you’re facing a debilitating or life-threatening illness, it’s nice to know you have someone in your corner to help you navigate the complexities of the health care system. That’s where a patient advocate comes into play.
Here’s What You Need to Know About Patient Advocates
In this article, we’ll take a look at what a patient advocate is, who needs to work with one and what kind of costs you’ll face to do so. Hint: You’re going to like the price if you follow our advice!
Table of Contents
- What Is a Patient Advocate?
- What Does a Patient Advocate Do?
- Who Needs a Patient Advocate?
- How Can You Find a Patient Advocate?
- What Can You Expect From the Patient Advocate Foundation?
- How Can a Patient Advocate Help With My Health Care Costs?
What Is a Patient Advocate?
A patient advocate acts as a liaison between a patient and the health care system. Dealing with insurance is obviously a big part of a patient advocate’s job. To that end, they can help with medical coding and billing issues, particularly when you have a life-threatening or debilitating illness.
“Professional case managers…work with patients with chronic or debilitating conditions to resolve health care access and affordability issues,” Caitlin E. Donovan, spokeswoman of the Patient Advocate Foundation, tells Clark.com. “They often have experience as nurses or social workers and are experts in medical billing and other issue areas.”
What Does a Patient Advocate Do?
Working from within the system, patient advocates have a multifaceted job that involves enhancing the experience of their patients by removing barriers to care, dealing with job retention issues so patients who have insurance can keep that coverage and helping the uninsured get set up with charity care or other available programs.
So to sum it all up, a patient advocate does the following:
- Helps you connect with financial support
- Can negotiate payment plans on your behalf
- Helps you navigate insurance complexities
- Assists with workplace issues so you can retain health-related workplace benefits
Who Needs a Patient Advocate?
One of the most common questions we get to Ask Clark — part of our suite of off-air opportunities for advice that money expert Clark Howard makes available for free — is “When do I need a patient advocate?”
If you or a loved one is facing a life-threatening or debilitating illness, it’s definitely a good idea to have a patient advocate on your side. They can be invaluable in helping to make sense of mysterious billing issues and make sure you’re getting the level of care you deserve.
If nothing else, they can be a trusted source to explain the process of what’s happening between your doctors and your insurance company.
“While someone may not necessarily need the services of a professional case manager — although anyone who has taken three months and 20 phone calls to resolve a simple billing error can tell you that one may always be helpful — we think pretty much everyone would benefit from an advocate on their side,” Donovan says, “for anything from attending a doctor’s appointment to helping to keep the bills and other crucial paperwork organized.”
How Can You Find a Patient Advocate?
Many hospitals have patient advocates on staff. However, if you ever sense there is a conflict of interest because their patient advocates work for the hospital system, you may want to find one on your own.
The Patient Advocate Foundation is a good clearinghouse in all 50 states for finding a patient advocate. And best of all, all services provided by the PAF are free for those facing a life-threatening or debilitating illness.
By connecting you with a free patient advocate, the PAF can assist qualifying customers up to four ways:
- Case Management Assistance
- Co-Pay Relief Program
- National Financial Resource Directory
- Financial Aid Funds
To get started, just fill out an online patient intake form. You can fill it out for yourself or as a family member or caregiver for another person.
But note this well: One thing the PAF won’t do is send its case managers to doctor appointments with patients.
What Can You Expect From the Patient Advocate Foundation?
As mentioned above, the PAF and their patient advocates have four main ways of helping people.
1. With Case Management Assistance, your patient advocate will assist with access to care, insurance issues, charity care, enrollment for federal and state programs like Medicare or the Health Insurance Marketplace and more.
2. The Co-Pay Relief Program offers financial assistance to patients with insurance to help them afford life-saving medications.
3. The National Financial Resource Directory is a database that can be used by both the insured and the uninsured to connect with a wide range of assistance, including:
- Affordable care options
- Childcare resources
- Clinical trial assistance
- Drug manufacturer patient programs
- Hospice & end of life services
- Housekeeping & repairs
- Housing & lodging
- Insurance premium assistance
- Rehabilitation assistance
- Transportation assistance
- Wish fulfillment
4. Finally, the PAF also has a separate list of Financial Aid Funds for a small handful of conditions. As of early 2020, funding was available through the Merkel Cell Carcinoma Financial Aid Fund and the Heart Valve Financial Aid Fund.
These are essentially grants for select medical conditions offered on a first come, first served basis.
The Merkel Cell Carcinoma Financial Aid Fund offers one-time assistance of $450 to cover transportation-related expenses connected to treatment appointments. Meanwhile, the Heart Valve Financial Aid Fund provides a one-time $600 grant to help with transportation, lodging, housing, utilities and food needs related to heart valve treatments.
How Can a Patient Advocate Help With Your Health Care Costs?
As mentioned earlier, PAF will pair you up with a free patient advocate if you have any of a number of common diagnosable life-threatening or debilitating illness.
In addition, you can get co-pay assistance for medication. Here’s a list of nearly two dozen common medical conditions that currently have open funds available for patients:
- Breast cancer
- Cancer genetic and genomic testing
- Cervical cancer
- Cystic Fibrosis
- Gaucher disease
- Hepatitis B
- HIV, AIDS and prevention
- Inherited or acquired lipodystrophy
- Metastatic melanoma
- Metastatic prostate cancer
- Multiple myeloma
- Multiple sclerosis
- Myelodysplastic syndromes
- Ovarian cancer
- Prostate cancer
- Pulmonary fibrosis
- Renal cell carcinoma
- Rheumatoid arthritis
- Ulcerative colitis
“[Our co-pay relief] helps people up to 400% of the federal poverty guidelines afford their medications,” Donovan says. “The funds are organized by disease area and in some instances can be used for insurance premiums or ancillary services associated with the disease.”
As you can see, there are multiple circumstances where a patient advocate can make a financial difference in your life.
Donovan advises not to fall into the trap of thinking your earn too much to receive assistance from the PAF.
“We have helped people who were upper income, but in danger of losing their home because of medical debt issues, and we have helped homeless people who needed paperwork help to access their cancer treatment,” she says. “Cases are not always so dire: People may be having trouble getting to their preferred medication because of insurance barriers or may need help getting into a clinical trial, for example.”
Meanwhile, if you’re already dealing with medical debt, you may want to see our article on How to Deal With Medical Debt.