October 18, 2021
Karen Balerna
What is a patient advocate? I am asked this question quite a bit. There are different types of advocates. You may have heard of an advocate that works for a hospital or an insurance company. The patient advocate that works for a hospital is there to help you understand your patient rights at that hospital and they also handle patient complaints. They can sometimes help with financial concerns as well. They work for the hospital and have the responsibility of covering all the patients within that hospital.
Health insurance companies also have patient advocates. These advocates help you navigate your insurance benefits and help you figure out what is covered and what you need to pay out of pocket for. They work for the insurance company, so they are there to help all of their insured.
There are also Private Patient Advocates, who work for you. Private patient advocates can be broken down into two categories; medical billing advocates and medical advocates. Billing advocates are usually people who previously worked for an insurance company or billing office. They know everything there is to know about billing codes and deductibles. They will look over your bills to make sure they are coded properly and make sure the insurance company has paid what they should pay. If you have a billing dispute, they will collect all the paperwork needed for the dispute and negotiate the bill for you. If you’ve ever had to dispute a medical bill, you know that it’s a hassle and can take hours out of your day making phone calls and faxing information back and forth to the insurance company and the providers. Some billing advocates can also make recommendations as to what insurance plan would be best for your specific situation during Open Enrollment.
Lastly, there are medical advocates. These advocates also work specifically for you, so they are looking out for your best interest. They are typically medical professionals who understand the complex healthcare system. We spend a lot of time with our clients and can pick up subtle changes in them, before they even realize something is wrong. We accompany them to their appointments, make sure their questions get answered and make sure they understand what the doctor is telling them. Have you ever left the doctor’s office and realized you forgot to ask your question or left there, not quite understanding what you are suppose to do next? There is so much important information discussed at a doctor’s visit and sometimes only half of that information is heard correctly or retained. Nurse advocates also keep updated medication lists and are the key person with you for all your doctors’ visits. Many times, especially if your doctors aren’t in the same health system, one doctor doesn’t know what another doctor has ordered for procedures, test, or medications. Medical errors are the 3rd leading cause of death in the US. Having a medical advocate with you helps to prevent duplication of tests, procedures, and labs and helps to reduce medical errors.
Karen Balerna RN BSN BCPA is a board certified patient advocate and owner of Nurse Advocate Partners, serving Beaufort County. Karen can be reached at KBalerna@NurseAdvocatePartners.com. www.NurseAdvocatePartners.com
