Why I Hope These Pigs Never Fly – and You Should, Too

This is the question that has plagued me as the director of a professional patient advocacy organization since it was first launched. It’s a question that usually comes from someone who is just thinking about becoming a patient advocate, one who hasn’t yet gotten his or her feet wet in our growing puddle of advocacy, ethics and best practices, although sometimes it comes from a more seasoned, yet not-yet-financially solvent advocate.

It is asked in a hopeful manner, as if it is the answer to prayers – or at least payment.

It’s at the very least naive, and at the most it shows a lack of understanding of the realities of the world of services we offer to clients who need us, but are hesitant to hire us.

The question:

Can my advocacy services be reimbursed by a patient’s insurance?


The answer is no – well, mostly no.

The answer is – we hope not.

And the answer is – that would be the death of private, independent advocacy as we know it.
Who would suffer the most? Patients, of course.

I outlined the reasons in a post right here almost two years ago. While there has been one change since then, the reasoning stays the same. Reimbursement for independent advocates would create a major conflict of interest, would be harmful to our clients, and would help us go bankrupt.

(Other than that, how was the play Mrs. Lincoln?)

That one change addresses reimbursement for physicians who act as advocates. As of early 2015, Medicare began to reimburse physicians $42 a month for “chronic care management.” For one thing, I see a possible conflict of interest if the doctor isn’t doing well by the patient to begin with; like asking the ineffective doctor fox to manage the patient chickens. (I realize here that I should probably apologize for all the animal metaphors in today’s post.) But secondly, it’s an insult to those who are good, skilled, compassionate physicians to suggest that if/when they actually perform those services as thoroughly as they should, that $42 in any way covers the cost of their time.

If insurance reimbursement for your advocacy services has ever been something you have pondered, or wished or hoped or prayed for, then you owe it to yourself to read the previous post on this topic.

Once you’ve done so, I suspect you, too, will hope those insurance-reimbursement pigs never fly.


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