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Industries & Professions /
As insurance companies, doctors, medical associations, and the U.S. government battle over health care insurance and the delivery of medical services, it can sometimes seem as if the interests of patients are being overlooked. Because the world of health care has become so complex in recent years, it's difficult for even the most informed patients to make sure changes in the system will benefit them. Health advocates enter this struggle on the patients' behalf, using their own health care expertise to promote the interests of patients in the private and public sectors.
Primarily, there are three types of health care advocates. Those who are employed by large companies such as hospitals, insurance companies, large physician groups, and other health organizations are often called patient representatives or consumer health advocates. The second category of health advocates works primarily for nonprofit organizations that deal with a wide variety of medical and insurance concerns, or they might work for a group that targets a particular illness or disease, such as cancer or lupus. The third group of health advocates works for private advocacy firms.
Many hospitals have seen the need and benefits of having a team devoted to resolving complaints of patients and their families and watching out for the interests of the patients as well as of the hospital. Patient representatives receive complaints from the patient or the family and work towards a resolution to the problem. The problem may range from issues between two patients sharing a room, to miscommunication between the patient and medical staff, to misplaced personal items. For example, if a patient felt mistreated by a hospital staff member, the patient representative must hear both sides of the case, determine if the claim is valid or a misunderstanding, and hopefully work out a peaceful and satisfactory resolution.
Patient representatives also document patients’ concerns and experience with the hospital and its staff. Complaints and the method of resolution are recorded to help in future cases. Measuring and recording patient satisfaction are important because the hospital uses this information in finding areas to improve. Another important role of representatives is to interpret medical procedures or unfamiliar medical terms and to answer patients’ questions in regards to hospital procedures or health insurance concerns. They also educate patients, as well as the hospital staff, about the patients’ bill of rights, advance directives, and issues of bioethics. Sometimes they handle special religious or dietary needs of the patient or personal requests, such as commemorating a birthday.
While patient representatives work for the patients’ well-being as well as their employer’s best interests, health advocates employed by nonprofits act as the patient’s champion against insurance companies, employers, and creditors. Many times patients are denied much-needed medical treatments because insurance companies consider them to be experimental. Certain drugs might be denied because of the way they are taken. Health advocates provide assistance in getting these issues resolved. They help identify the type of health insurance and the depth of coverage the patient has and organize paperwork and referrals from physicians and hospitals. Sometimes patients also need help composing letters to insurance companies explaining their situation. Health advocates also make phone calls to physicians and insurance companies on behalf of the patient.
Patients sometimes encounter job discrimination because of an existing illness or extended medical leaves, and this is another area in which health advocates can help. Many nonprofit groups also have lawyers on staff who provide legal counsel. Also, with any serious illness, financial concerns are likely. Health advocates can offer suggestions on how to get the most from a patient’s insurance coverage, negotiate with physicians and hospitals to lower costs, and work with pharmaceutical companies in providing expensive medications at a lower cost.
Health advocates may choose to work independent of a hospital, group, or organization. Such advocates act as consultants and may have their own private practice or work for an advocacy firm. Their cases usually involve patients with a variety of issues and concerns. They usually charge a flat fee per case.