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frequently asked questions

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Patient advocacy is still a relatively new field in health care, and so we expect that many of you will have questions—the who, what, why, and how of it all. We have therefore created this list of commonly asked questions and answers to assist you. However, please CONTACT US if you have any questions that are not specifically listed here or if you need further clarification about any of our answers.

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Is “patient advocacy” a new field or profession in health care?

Yes and no. The term “patient advocacy” can apply to any activity that ultimately benefits patients, so in this sense, patient advocacy is not a new concept. For example, tens of thousands of people serve as volunteer patient advocates for their friends and loved ones— think of the man who helps his grandmother sort through confusing medical bills. And health care professionals perform some of the services that a patient advocate provides—think of the nurse who provides emotional support to her patients on a hospital floor.

In addition, hospitals in the United States have been employing hospital advocates (usually as part of their risk management teams) for decades. These non-medical personnel work under a variety of different titles, including “patient representative,” “ombudsman,” and even “patient advocate.” Their job is to provide customer service to patients, such as addressing a patient’s complaints during his/her hospital stay.

However, it is really only over the past decade that professional, private patient advocacy has started to blossom as a well-defined, cohesive, and organized profession in health care. Currently, there are approximately 300 full-time private patient advocacy businesses in the United States. And as more people start to realize that life as a patient is easier, safer, and less stressful with the involvement of an intelligent and savvy patient advocate, the more patient advocacy firms we will see develop.

What is the difference between a patient advocate and a health care navigator?

There is no meaningful difference. These titles are used interchangeably throughout the website. At Health Care Navigators, LLC, we we simply call our patient advocates “health care navigators.”

If a hospital already has a hospital advocate, patient representative, or ombudsman
on its staff, then why would I need to hire my own health care navigator?

While a hospital advocate may be helpful in providing you with information, his/her ability to advocate for you is severely limited by the fact that he/she receives a pay check from the hospital and therefore has a financial incentive to advocate most strongly for the hospital, NOT FOR YOU.  In cases involving a conflict of interest, the main priority of the hospital advocate is damage control for the hospital, not patient advocacy for you.

Why would I need to hire a patient advocate/health care navigator when I already
have doctors, nurses, and other hospital staff taking care of me?

Most doctors, nurses, and other health care professionals will tell you that “patient advocacy” is part of their job description, and this is true if we define patient advocacy generally as “anything that ultimately benefits a patient.”  However, there is no way that a doctor or a nurse (or any other health care professional, for that matter) will have the time or the qualifications to provide you with the comprehensive and personalized services that your health care navigator will offer to you.

Most importantly, health care navigators provide services that are not provided by anyone else. For example, no doctor or nurse will spend hours negotiating with your insurance company in the event of a denial of a claim, or negotiate with the hospital billing department on your behalf to get your bills reduced.  That is simply not in anyone else’s job description.  Other examples include:  attending doctors’ visits with you to make sure that you are asking the right questions and getting satisfactory answers; requesting and organizing your medical records in preparation for a second opinion; locating the best surgeon, acupuncturist, or nursing home; and almost anything else that you need.  

In addition, health care navigators provide services that others should provide, but in reality do not.  For example, no health care professional will prepare and provide you with detailed and organized research on your diagnosis (including treatment options, alternative theories, holistic healing options, specialists in the field, etc.) of the same high quality as a patient advocate would provide. Similarly, no health care professional will provide you with the same extent of emotional or logistical support to aid you in making your decisions. While you may think that it is the job of your primary care physician (PCP) to do exactly this type of thing—and a great PCP arguably should— the reality is that most PCPs do not have the time or the financial incentives to engage in such lengthy research, conversation, and support.

Your PCP is also supposed to coordinate among all of your specialists if you are battling a serious disease that requires input from numerous specialties. However, PCPs have many patients and little time, and so they often fail to create a cohesive health care team that is in regular communication (especially if some of your physicians practice at different hospitals). If you are dealing with a life-threatening disease, you need a health care navigator to make sure that you not only have the best health care team available but also that each member of that team regularly communicates about your case.  A breakdown of communication or the failure to implement a team-based approach to healing can have dire consequences to you, the patient.

A final and more serious example of the patient advocate filling the gaps caused by overworked health care workers is the case of hospital-acquired infections and medical mistakes. Health care professionals are supposed to keep you safe while you are in the hospital. Yet 100,000 people die annually in the United States from hospital-acquired infections, and another 44,000 to 90,000 die annually from other medical errors.  Although it is true that health care professionals should work together to keep you safe, the reality is that they are not doing a good enough job.  However, if you have a health care navigator by your side, your chances of ending up like one of the patients described in our Patient Stories section will be greatly reduced. 

In short, a health care navigator is an invaluable addition to your health care/wellness team.

Why can’t a family member or loved one be my patient advocate/health care navigator?

Although your family members love you and have your best interests at heart, they can be overly emotional for exactly the same reasons. They may lack the qualifications, experience, and objectivity to navigate the health care system and advocate on your behalf.  In addition, your health care navigator will be by your side whenever you need him/her, while most family members (sooner or later) have to return to their own lives.

Why can’t I just be my own advocate and navigate the healthcare system myself?

It should not be surprising that the health care system can be outright torturous for someone who is easily overwhelmed by medical jargon and complicated medical forms, or who is shy by nature and scared to ask questions, or who is generally intimidated by doctors.  But the health care system is complex and overwhelming even for someone who is intelligent, educated, and assertive.  Perhaps the reason for this is that when we are sick (or when a loved one is sick) we are simply not at our best.  Nobody is going to be able to understand quickly or decide easily when fatigue and fear are present; yet it is precisely when a person’s health or life is at stake that comprehension and decisive action are crucial. Your health care navigator will guide you through the medical maze from start to finish so that you won’t get lost along the way.

I can understand hiring a patient advocate/health care navigator if I am being admitted to the hospital for surgery or if I have a serious or life-threatening disease. But why would I need to hire one if I am currently healthy?

To ensure that you stay healthy! Do you currently have all of your medical records organized and readily available? Do you have a specific health issue that you would like to address such as weight, smoking, etc.? Do you need help locating a new primary care physician, dentist, or other specialist? Do you feel that you waste valuable time talking on the phone with your health insurance company or booking regular doctors’ appointments? Do you need help choosing a health insurance plan that is right for you? Do you need help applying for Medicare coverage? If you answered “yes” to any of these questions, then you should definitely consider hiring a health care navigator.

I am an employer and while I am sure that my employees would benefit from your services, how would I benefit? Times are tough right now economically, and I need to pay attention to the bottom line if my business is to succeed.

That’s right; you do need to pay attention to the bottom line. And a healthy and happy workforce is a productive workforce. By offering workplace wellness programs (such as smoking cessation and weight management classes, meditation classes for stress relief, etc.) as well as useful information (such as how to choose a doctor or how to prepare for an upcoming surgery), you will be increasing the health and morale of your employees. As a result, they will be more motivated and productive at work.

You should also know that if your employees are wasting company time talking on the phone and doing online research, or taking sick days because either they or their loved ones are dealing with a health concern, insurance problem, or other medical matter, then you, the employer, will lose money at the end of the day. Your health care navigator can help you to institute successful workplace wellness programs and can advocate for your employees on an individual basis as well (e.g. when they face personal/family health crises, have questions about the health care system, or need help understanding their own health insurance coverage).  Hiring a health care navigator will therefore not only benefit your employees, but will also benefit you and the company as a whole.

If hiring a patient advocate/health care navigator were really so crucial, why has my doctor not suggested that I do so?

Private, professional patient advocacy is still a relatively new field in health care, and as such, many doctors are not yet accustomed to having a patient advocate on the health care team. Additionally, some doctors incorrectly assume that patient advocates are litigious and antagonistic (perhaps similar to how they view personal injury lawyers) and that they will therefore make a doctor’s job more challenging. On the contrary, a patient advocate greatly enhances communication between patient and provider, making the doctor’s job significantly easier. Finally, some doctors believe that they are completely capable of ensuring that their patients receive the best medical care possible, without the involvement of a patient advocate. Despite this confidence, however, reality clearly shows otherwise.

Physicians who understand what patient advocates do tend to enthusiastically welcome their participation, because these physicians know that a patient advocate will be able to support a patient in ways and to an extent that a physician cannot.

Will my health insurance company pay for the services that you provide?

No. Currently health insurance companies do not pay for the services provided by private patient advocacy companies. We in the patient advocacy profession hope that this will not always be the case, but for now you will need to pay for our services out-of-pocket.

What qualifications should I look for in a patient advocate/health care navigator?

Currently, there is no national accreditation or licensing requirement for patient advocates, so technically anybody can hang out a shingle that advertises “patient advocacy.” Therefore, do your homework and be careful when choosing a patient advocate. Do not be afraid to ask about education and credentials. Ask for references. You will want to make sure that your patient advocate has extensive experience dealing with the health care system, and that he/she is personable, intelligent, assertive, and creative.

What makes Health Care Navigators, LLC different from other patient advocacy firms?

Please see Why Hire Us. Not all patient advocacy businesses are created equal, and when your health is at stake, you deserve the best. Health Care Navigators, LLC is the only company that provides exclusive, comprehensive, and personalized patient advocacy services, with around-the-clock availability in the case of an emergency.

Can my health care navigator give me medical or legal advice?

No. Although many of our health care navigators have educational and professional backgrounds in law and medicine, we are a patient advocacy business—not a law office or medical practice. While we will provide you with recommendations for doctors and lawyers when necessary, as part of our services, we will not provide you with any specific medical or legal advice.

Do you have a different question not answered here? If so, please CONTACT US so that we can help you.

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800 518 8573

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Health Care Navigators, LLC
258 Harvard Street #474
Brookline, MA 02446

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