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The Patient-Advocate - 7/2/2008 7:38:03 AM

candystripper

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We Americans are living with a medical care delivery system in a state of flux -- some would say confuson. Maybe this is true for people in other countries; I don't know.

So many factors play into this flux, but a few are:

* We're moving from a profit-based medical system to what will probably be a modifed profit-based system.

* All providers, from MDs to pharmecutical companies to pharmacies are distressed at what they perceive as loss of future income. IMO, in some cases it's a reality-based fear. In others IMO it's frustrated greed.

* We're widely-perceived as a highly litigious society, but in fact many states have passed right-to-sue or one year statue of limitations laws, closing the courthouse doors on patients. This leaves many care givers essentially unregulated, as boards which govern licensees are notoriously toothless.

* Many of us have been shoved into HMOs, which is like a mini-world with its own rules and regulations, mostly aimed at preventing the HMO from incurring 'avoidable' costs.

So IMO, the American patient can no longer afford to be passive, and at the same time, cannot run off to attend medical school either.

What is a patient advocate?

* One who has moved from MD to MD and pharmacy to pharmacy, etc. until they find a care giver they feel confidence in.

* One who does not accept 'there's nothing we can do', 'we can do no more' or 'you'll have to learn to live with it' until they've fully explored care givers and treatments.

* One who asks a lot of questions about meds and surgeries, and then asks the opinion of a second care giver if they feel a need to.

* One who has made the requisite provision for the possibility that they might be unable to make medical decisions for themselves, such as a medical durable power of attorney.

These are just examples. Patient-advocates read medical news. They disobey care givers when the advice makes no sense. They seek out alternatives to treatment if the first one suggested is unappealing. They work hard to be well-poised in the event they are struck by a catastrophic illness or injury. They know their insurance coverage and how to maximize it. They buy additional insurance where possible and well-advised.

We all (I assume) want to live out our lives, in our homes, with a measure of dignity, free of pain and debilitating conditions.

Some of us will sail through till we're hit by a bus.

Most of us need to learn to advocate for ourselves.

candystripper

< Message edited by candystripper -- 7/2/2008 7:41:43 AM >

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RE: The Patient-Advocate - 7/2/2008 10:46:22 AM

TermsConditions

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You must advocate for yourself or have someone that can advocate for you. 100% End to end. An always ask for an itemized invoice.

I wonder what % of the cost of healthcare results from the cost of dealing with insurance companies?

When I walk into my allergist or GPs office or take the kids to an appointment there is one staff person working reception and 3-6 staff persons working on insurance paperwork and phone calls to insurance companies.

Insurance companies do not have standardized processes or forms. Each HC provider must interface uniquely with each company.

My spouse's employer (500 employees) has a full time person to deal with health insurance snafu's with their insurance company.

When our claims are mishandled by the insurance company (almost monthly) I must fax a copy of the EOB and claim to the insurance rep because the rep does not have access to the original claim form. I have multiple sets of instructions for submitting the same form. The results differ from month to month. What worked in April might not work in June.

Change is good.

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RE: The Patient-Advocate - 7/2/2008 1:53:45 PM

camille65

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I thought there was a totally different definition to 'patient advocate', that it did not mean a pro-active patient but instead someone actually advocating on behalf of the patient.
As a patient myself, I investigate and do research on things that concern me such as prescription medication but never did I think that was being a patient advocate.

Maybe I am just confused and need someone to advocate for me in regards to my pain meds.

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RE: The Patient-Advocate - 7/2/2008 1:56:41 PM

camille65

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From the dreaded Wiki:
Patient advocacy refers to speaking on behalf of a patient in order to protect their rights and help them obtain needed information and services. The role of patient advocate is frequently assumed by nurses, social workers, and other healthcare providers. Some hospitals, health insurance companies, and other healthcare organizations employ people specifically to assume this role.

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RE: The Patient-Advocate - 7/2/2008 3:10:45 PM

CalifChick

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Camille: It took me a minute or three but I finally figured out that she meant "patient as self-advocate". At least, that's what I think she meant. The term "patient advocate" still does indeed mean someone who advocates on behalf of a patient (and if you're in the hospital and something isn't right and attempts to correct it are in vain, dial the hospital operator and ask to be connected to the patient advocate's office).

Cali

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RE: The Patient-Advocate - 7/2/2008 3:31:55 PM

JstAnotherSub

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amen! i can not say enough about how the patient advocates at the local hospital helped me break down brick walls for the 10 years my mom was sick. they are right up there with hospice workers, angels on earth, as far as i am concerned.

it seems to me that the op was simply describing someone who tries to be knowledgable about their own health care. i would hope we all try to do that, to the best of our ability.

but if you hit a brick wall, i highly recommend getting in touch with a patient advocate to help you through the maze.

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RE: The Patient-Advocate - 7/4/2008 12:53:06 AM

candystripper

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quote:

ORIGINAL: TermsConditions

You must advocate for yourself or have someone that can advocate for you. 100% End to end. An always ask for an itemized invoice.

I wonder what % of the cost of healthcare results from the cost of dealing with insurance companies?

When I walk into my allergist or GPs office or take the kids to an appointment there is one staff person working reception and 3-6 staff persons working on insurance paperwork and phone calls to insurance companies.

Insurance companies do not have standardized processes or forms. Each HC provider must interface uniquely with each company.

My spouse's employer (500 employees) has a full time person to deal with health insurance snafu's with their insurance company.

When our claims are mishandled by the insurance company (almost monthly) I must fax a copy of the EOB and claim to the insurance rep because the rep does not have access to the original claim form. I have multiple sets of instructions for submitting the same form. The results differ from month to month. What worked in April might not work in June.

Change is good.

This is not accidential.

Insurance companies are among the pigs at the trough, trying to 'maximize income' by denying legitimate claims.

Hospitals add to the confusion by using a 'charge master' which spits out a different cost for each item or service, depending on the patient's coverage, insurer, MD and the way the f**king wind is blowng.

It's all designed to force payees to give up and absorb the cost themselves.

candystripper

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RE: The Patient-Advocate - 7/4/2008 12:55:41 AM

candystripper

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quote:

ORIGINAL: camille65

I thought there was a totally different definition to 'patient advocate', that it did not mean a pro-active patient but instead someone actually advocating on behalf of the patient.
As a patient myself, I investigate and do research on things that concern me such as prescription medication but never did I think that was being a patient advocate.

Maybe I am just confused and need someone to advocate for me in regards to my pain meds.

quote:

.....amen! i can not say enough about how the patient advocates at the local hospital helped me break down brick walls for the 10 years my mom was sick. they are right up there with hospice workers, angels on earth, as far as i am concerned....

JstAnotherSub

There's someone advocating for a patient? Apart from the patient himself or his medical decision-maker?

candystripper

< Message edited by candystripper -- 7/4/2008 12:57:57 AM >

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RE: The Patient-Advocate - 7/4/2008 4:24:46 AM

pixidustpet

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quote:

ORIGINAL: candystripper

There's someone advocating for a patient? Apart from the patient himself or his medical decision-maker?

candystripper

yes. that is their only job, to interviene and make sure the patient is getting the best care possible.

the one i dealt with when fallcon was dying listened to me about his meds being changed with no reason, about one nurse who LIED about his meds being given, and gave us a palliative care doctor who made sure he was no longer in pain. she also was able to talk to me about what we could do to make sure stuff like this nevr happened again.

sometimes staff at hospitals (especially teaching hospitals) forget that patients are human beings. and the patient advocate is there to bridge the gap and bring both sides together again.

kitten

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