After a new diagnosis, you have a lot to learn and do. How to pay your medical bills is just one of many questions on your list, but it’s likely near the top. Navigating insurance coverage and costs might feel overwhelming, but you're not alone. A patient advocate can help.
A patient advocate is a person who guides you through your diagnosis and treatment. They don't make health care decisions for you. Instead, they give you the information you need to make the best decisions for yourself — including how to pay for your treatment.
"Many patients come to patient advocates because they have barriers to receiving care, whether it's financial, geographical, or insurance barriers, or they've had insurance coverage denied," says Gwen Darien, chief patient engagement officer at the Patient Advocate Foundation. "We walk alongside a patient, help to empower them, and help them gain self-advocacy skills."
What Are Patient Advocates?
A patient advocate is often a person who is trained to help people navigate the healthcare system. Some are professionals who do the job for a living. Others advocate as part of another job. For example, social workers and nurses sometimes help patients find coverage and other financial resources to pay for their medical care.
Many patient advocates started out as patients themselves. Darien is a four-time cancer survivor. "That's one of the reasons I went into patient advocacy," she says. "It was a way to help people not go through some of the same things that I went through, like a delayed diagnosis."
What Kind of Training Do Patient Advocates Have?
Many patient advocates have a degree in one of these fields:
- Nursing
- Social work
- Healthcare administration
- Psychology
- Public health
- Health science
Some patient advocates have worked in a hospital or medical office. Others are patients like you, who gained experience when they advocated for themselves or a loved one.
Professional patient advocates can be certified. This means they have passed an exam from the Patient Advocate Certification Board. Or they may have taken a training course or bootcamp from an organization like the Alliance of Professional Health Advocates, to learn the skills they need for the job.
What Do Patient Advocates Do?
The healthcare system can be confusing. Medical bills and health insurance coverage aren't always clear. Your patient advocate helps you understand what your health insurance plan includes and how much you'll have to pay out of pocket. They explain your bills and look for ways to pay for services your insurance won't cover.
Patient advocates are your guides during treatment. They help you find the financial resources and assistance you need.
An advocate can help you:
Understand your insurance coverage. Your advocate will explain your premiums, copays, and deductibles. They'll tell you what your insurance plan covers and what it doesn't cover. If your insurance company denies a claim, the advocate will help you file an appeal.
Pay your medical bills. The patient advocate works with your hospital's billing department and your insurance company to get your medical bills paid. They also look for mistakes in your bill and negotiate down any medical debt you have.
Lower your costs. They try to reduce your bills and request a payment plan if you need to pay a little at a time.
Cover other costs. If you need help paying for transportation, housing, or food, a patient advocate can make these services more affordable.
Apply for financial assistance. "Many of our patients experience financial difficulties," says Amy Klein, LCSW, network director, social work, in the Department of Social Work at Montefiore Health System in New York. Advocates like Klein know which programs and organizations make care more affordable or help you cover medical costs.
Some are government programs, such as Medicare, Medicaid, and Social Security Disability Insurance (SSDI). Others are nonprofit organizations that offer financial help to people with certain conditions, such as cancer patients or those who've had an organ transplant.
Your advocate will point you to the right programs and coordinate with your doctors to help you apply. They also can connect you with drug companies' financial assistance programs. "These can help bring down the cost of an expensive drug and make it easier for patients to get their medications," Klein says.
Where Can You Find a Patient Advocate?
Call your hospital or doctor's office and ask if they have a patient advocate on staff. Some nonprofit groups, such as cancer organizations, also offer this service. Or search online for a private patient advocate.
The Patient Advocate Foundation is another good resource. This nonprofit organization helps people with chronic or serious conditions pay for their care. Their TotalAssist Program offers grants to cover out-of-pocket treatment costs, including medication, health insurance premiums, deductibles, coinsurance, and copays.
What Skills Should a Patient Advocate Have?
The patient advocate you work with should communicate clearly, be a good problem solver, and really listen to you. "The most important skill is actively listening to what people's goals are and what they hope to achieve with treatment," Darien says.
Your patient advocate should know where to find the resources you need and make you a partner in any financial decisions they suggest.
Be careful to avoid credit scammers who pose as patient advocates. Anyone who promises to clear your medical debt or fix your credit for an upfront fee is not looking out for you.
How Much Does a Patient Advocate Cost?
The patient advocate at a hospital or clinic offers help at no additional cost to you. "These services are included in the cost of hospital admission. They are not billed separately," Klein says.
Patient advocates who work independently may charge $70 or more per hour. Insurance often won't cover the cost.
If you can't afford a patient advocate and your hospital doesn't have one on staff, the Patient Advocate Foundation provides this service for free. Disease-specific organizations like the American Kidney Fund also offer help with medical bills. So do groups like the PAN Foundation and HealthWell Foundation.
Do You Need a Patient Advocate?
You might need a patient advocate if you're diagnosed with a serious or chronic illness. They're especially helpful when you need advice on insurance coverage or help paying your medical bills.
Don't be afraid to reach out for financial advice when you need it. One of the most important lessons Darien learned during her cancer journey was to ask for help. "Patient advocates and patient advocacy organizations can help you ask for help," she says.
Show Sources
Photo Credit: Moment/Getty Images
SOURCES:
Gwen Darien, chief patient engagement officer, Patient Advocate Foundation, Hampton, Virginia.
Amy Klein, licensed clinical social worker; network director, social work, Department of Social Work, Montefiore Health System, New York.
Alliance of Professional Health Advocates: "Patient Advocacy Boot Camp."
American College of Education: "Career Guide: Patient Advocate."
CMS.gov: "Find a Patient Advocate."
Friends of Cancer Research: "Patient Advocacy."
Johns Hopkins Medicine: "The Power of a Health Care Advocate."
National Cancer Institute: "Patient Advocate."
Nationwide Children's: "Health Newcomer: The Patient Advocate."
Patient Advocate Certification Board: "BCPA = Board Certified Patient Advocate."
Patient Advocate Foundation: "Frequently Asked Questions," "TotalAssist."
Umbra Health Advocacy: "What Is the Cost to Hire a Patient Advocate?"
Western Governors University: "Patient Advocate Career."
