Face it - when you are sick or debilitated, it's impossible to figure out how to get the best from the healthcare system, or how to be sure you aren't being taken for a ride. Knowing that you may have been misdiagnosed, or that you haven't been told about all your treatment options, or that your bills are being tampered with can cause you enough stress as to make your condition even worse.
Sometimes the only way to be sure you get the best service and outcomes possible from the healthcare system is to find someone else to help you navigate through the maze of providers, tests, treatments and of course, medical bills you'll encounter.
But finding "someone else" and finding an expert, are two different things. Your sister or spouse may be able to help you. A neighbor who works in a doctors office might help you. But the most professional and objective help you're going to find will come from a private health advocate, also called a patient advocate or navigator - someone who knows the ins and outs of the system, and can facilitate your path to recovery, or at least make your medical challenges easier to weather.
(A quick distinction here. There are many kinds of patient and health advocates, but not all will be totally devoted to your care. Learn these distinctions and why a private advocate is what you're looking for.)
Paying for Private Advocacy Services
While so many of the services we get for our healthcare are covered by our insurance, private advocates are not. That may initially sound like a negative - that in order to get help from a patient advocate or navigator you would have to pay for the service out of your pocket. But that's really to your benefit. Here's why:
When services are covered by your insurance, they are, by definition, limited. Your doctor won't spend as much time with you because she will only be reimbursed X amount of money. Or, your stay in the hospital will be limited because your insurance only covers X number of days. Your insurance dictates your care.
But when you pay for something privately, then the only limit is your own limit -what you are willing to pay for. And when you hire an advocate to be on your side, it might be the advocate who knows how to squeeze an extra 15 minutes out of the doctor appointment, or the extra few days out of your hospital stay.
The whole point is to improve the quality of your care by having an expert on your side who is solely devoted to that improvement in the quality of your care.
Or - look at it another way: The reason you hire a real estate broker to help you buy or sell a home is because he or she is the expert. Sure - you could buy a "for sale by owner" without a broker - but what if something went wrong? You don't know what you don't know - but brokers do know because they deal in real estate every day. So it's worth the extra expense.
The reason you hire a CPA is because you want an expert to help you with your taxes. Sure, you could use tax software, or a pencil and a calculator, and do it yourself. But what if you missed a deduction? Or what if you don't understand a form? Again - you don't know what you don't know - but a CPA does know because that's her area of expertise. It's worth the extra expense.
Those examples address your home and your taxes. And neither is nearly as important as your health, or your life. So spending the money on a professional advocate is worth it - because you don't know what you don't know.
How the Cost of Advocacy Services is Determined
The cost to hire a private advocate will depend on a few things:
1. The types of services and complexity of your need.
There are perhaps dozens of services health advocates might provide to you, ranging from explaining your treatment options to reviewing your hospital bills, from uncovering clinical trials appropriate to your need, to getting your insurance company to pay a claim you think should be covered. Each service will cost something different to accomplish, mostly as a function of the time it takes to accomplish it.
2. The background and expertise of the person you will hire.
Just as would be true in any service business, the more credentials an advocate has achieved, the more it will cost to hire that person. A physician who has gone into private advocacy practice will charge more for her services than someone whose expertise has only been developed by helping his wife through her cancer diagnosis. The person who has worked in health insurance claims for 10 years will charge more than the person who just finished taking a weekend course in how to get the insurer to pay up.
Further, some advocates have developed specific niches to their work which becomes a benefit to you, and will be worth a higher price. (And, truthfully, it could end up costing you less in the long run because that person is so good at what he or she does.) If you need to determine your next steps after a devastating cancer diagnosis, then working with an expert in Shared Decision Making may cost you less (because the decision aids used are pre-developed by experts), and provide more quality to your life, than hiring an advocate would would have to research your options on her own, then walk you through the pros and cons, and would charge you for the time it took her to do all that research.
It's important for you to establish and understand the credentials of any advocate you hire. That's one of the recommendations in a list of questions that help you choose the right advocate for you.
3. Your geographic location.
Just as there are variations in cost for almost anything we buy based on where we live, the same is true for health advocacy services. A medical/navigational advocate with a nursing background in San Francisco or Boston or New York City will command a higher hourly rate than someone with an identical background who practices in Boise, Syracuse or Amarillo.