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Is Patient Advocacy Becoming a Specialized Field of It’s Own

Posted Aug 09 2009 10:58pm

Patient Advocacy is very much needed today, but what type of help do you need is the question addressed here.  Is it your bill that was maybe not coded correctly, is it fighting for something that the insurance company denied that you feel is covered?  Those are just a couple of many areas image where you can indeed need help and Healthcare advocacy just like healthcare can be a complicated path too.  You may even be sent in several directions too, again depending on the area where help is needed. 

It is possible too that you may need more than one source, again depending on the situation.  There’s always the last resort of an attorney as well and most advocates will usually find all the other routes first before going this route if there are errors or items missed, or those you can dispute before having to go to this final step.  As mentioned, this is almost making the IRS day of April 15th look easy.   On the web, there’s the normal help yourself areas where you can begin to explore.  Bottom line is the fact that we have a healthcare system that is so complicated today that needs reform in so many areas that it is getting complicated to get sick and to know what will and will not be covered.  

Don’t be fooled on some accounts though, it’s all the computer code and algorithms that run and create your bill from the start and changing and/or altering the practices of how the code or structured query language runs is the solution, programmers make those changes based on laws that are passed.   We work with algorithms every day on social networks and see those change and upgrade for a simple example.  

Word to the wise is read up as best you can and don’t forget that it comes down to the Health IT portion of the business that creates the need for patient advocacy to weed through and understand why and where all of this is created and it’s not getting any easier out there as each area needs to take a certain amount of dollars for their contributions to the system, in software and algorithms, the middle man does get paid and quite well in some areas in risk management to keep these costs to a minimum and we pay for that too.  

To simplify this process would mean that some of the healthcare dollars that software experts charge for with their business intelligence services could go away if we had additional non profits that provided this service instead of those for profit, and then perhaps progress could be made in lowing healthcare costs instead of having to pay for this expertise and they make billions.  We pay big money for 3rd parties to direct and tell us how to save money and the healthcare advocates wrestles through all of this too as some of it does get into some very complicated legal areas, all to make sure you have not been over charged or billed erroneously.  If you need help, find an advocate that also networks with other advocates so you can get the help you need.  BD  

These days, dealing with medical bills and insurance claims makes April 15 look easy. The medical jargon and inscrutable coding on invoices and explanations of benefits are indecipherable for most lay people. Worse, seriously ill patients may simply be too sick or too broke to deal with the mountains of red tape. That can lead to unpaid medical debts and even bankruptcy.

In general, medical billing advocates help you find errors in your bills, negotiate with your insurer to appeal coverage denials, or negotiate lower fees with your medical care providers. Some advocates do all three tasks equally well. But others, because of their training or background, may specialize in one area or another. image

Five months after the accident, just when she thought she had paid everything off, she got a bill for $16,000 from the helicopter ambulance service that ferried her from the remote location in Colorado where the accident occurred to a large medical facility 75 miles away. “I was completely taken by surprise to get this bill so long after the accident happened,” Ms. Redstone said.

The Medical Billing Advocates of America does list advocates in various states and by specialties on its Web site at http://www.billadvocates.com, but an advocate is listed only if he or she has completed — and paid for — courses sponsored by the organization.

If you need help handling a dispute with your insurance company, advocates who have a background in insurance claims departments or lawyers with a strong health care background often have the skills you’re looking for. Be sure to ask for several references of previous clients with cases where the advocate has successfully negotiated with an insurance company.

Patient Money - A New Kind of Sherpa - the Medical Advocate - NYTimes.com

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