1. Health

Can a Patient Advocate or Patient Navigator Help You?

The Answer Depends on the Allegiance Factor


Updated February 10, 2013

As the healthcare system becomes more and more confusing and complex, as we begin to hear terms like healthcare exchanges or marketplaces, or as we have questions about ObamaCare or simply why our doctors are now staring at computers or tablets instead of talking directly to us...

We begin to wonder what kind of help might be available to provide guidance for the medical care we need, and the peace of mind we wish for.

It's just not so simple anymore. We can't just call a doctor, make an appointment, and show up. Permissions have to be gained from our payers, or referrals have to be made weeks ahead of time. Doctors don't tend to share decision-making with us, nor do they coordinate our care among all the doctors we see. Co-pays have to be produced and EOBs have to be reviewed later.

Doctors are in a bigger hurry than ever before. We feel shoved out the door and only later do we think of questions we should have asked. Treatment doesn't seem to work - or - does it? How do we know we were even diagnosed accurately? And what's all this about medical errors? Then, to top it all off, whose to say our medical bills are accurate, or not, or even belong to us instead of someone else?

In any other confounding aspect of life, we call in professionals. If you need a complex will written, or you want a divorce, or you are selling your house, you call a lawyer. If you have questions about your taxes and how they are affected by your inheritance from Great Aunt Sally or the burgler who stole your jewelry, then you call a tax accountant. If your car is making a strange noise and you don't know the first thing about the engine, then you call your mechanic. If your hair needs a good cut, and you are all Edward Scissorhands, then you visit your hairdresser.

And if your medical care or your medical bills are at all challenging, then you should contact a patient advocate for help, too.

Choosing a patient advocate doesn't have to be complicated. But what you do need to know is that there are some factors to be considered about which kind of advocate will focus on your best interests. The terms "patient advocate" and "patient navigator" are being used by so many kinds of service people, that you'll want to be sure you find the kind that works best for you.

As you go through the process of choosing a patient advocate, what will be most important to you is where that advocate's or navigator's allegiance lies.

The Patient Advocate Allegiance Factor

There are many kinds of advocates and navigators who may be available to help you. But there is a huge distinction when it comes to which ones will be primarily focused on your best interests. It's not that all advocates don't want to help you or do well by you. It's that there may be another entity or circumstance that is the advocate's priority, putting you (at least) second.

The Allegiance Factor is based on where payment for the service comes from, and whether that suggests a conflict of interest, as follows:

  • A hospital patient advocate may be able to help you sort out some of the problems you have in the hospital. But his allegiance will be to the hospital because that's who provides his paycheck. If he has to choose between helping you or helping the hospital, you'll be on the short end of that stick. Further, what kind of help can you get from that person before you enter, or after you leave the hospital? None.

  • An insurance company patient advocate gets his paycheck from the insurance company. As long as your goal is to save them money, they'll be very helpful. But their goal is to bring in as much money from YOU as possible, and pay as little out on your behalf as possible. That is a clear conflict of interest when it comes to primary interest and whether an insurance company patient advocate can help you.

  • The term "navigator" is being used to describe a variety of forms of help, some of which may be more helpful to you than others. Again - you need to determine where that person's allegiance lies. A cancer navigator working for a hospital may be very helpful to you while you are there at the hospital, but she won't be the person to help you get a second opinion, nor will she be helping you choose from different treatment options. An insurance navigator may be very helpful when it comes to choosing which insurance plan is right for you - unless he is being paid by insurance companies to make recommendations. Determine a navigator's allegiance to help you decide whether they have your best interests in mind.

  • Private advocates work directly for a patient and are paid either by the patient or by a benefactor of the patient. Benefactors may include a patient's family member, a patient's attorney or other guardian, the patient's employer or labor union, even the patient's church or synagogue - anyone, or any organization that will not profit by, or lose money from the advo acy transaction. A private, independent advocate's only allegiance is to the patient she is helping.

When it comes to trusting a patient advocate or navigator, keep in mind the Allegiance Factor and let that be your guide to choosing the right person to help you.

Learn more about choosing a patient advocate or navigator.

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