I had interesting conversations with someday-advocates last week. I love those conversations; I always learn something from them which I can then bring back to the Alliance and the information we share with members.
And then again, sometimes the questions I hear are the same ones that have cropped up over and over again, including today’s question: Is there insurance reimbursement for the work of an independent advocate?
This time, I’m going to answer that question with a few questions of my own.
When we call an advocate independent, what do we mean?
Independent of what?
The answer is usually, “Well – independent of the healthcare system!”
OK. Next question.
What parts of the healthcare system are they independent of?
Well… the whole system! The system is so dysfunctional that people aren’t getting what they need! As an independent advocate, I will be able to get them what they need!
OK. Next question.
Why aren’t they getting what they need?
Because they can’t talk to their doctors anymore! There isn’t enough time. Doctors are in such a hurry, and patients want their hands held like they used to. They want their doctors to listen to them. They want someone who will help them get what they really need and want. They want explanations and understanding. That’s what I bring as their advocate!
OK. Next question.
Why don’t their doctors listen to them?
Why aren’t they getting the time they used to get?
Why do they need you?
This is the point where the light bulb goes off in their heads, and they realize what they’ve just said….
One of THE BIGGEST HURDLES to patients getting what they want and need is the providers’ reimbursement system. Providers are NEVER reimbursed for the TIME they spend with patients. They are reimbursed per-patient, and the more patients they see in one day, the more money they can make. Insurers have put such a squeeze on providers that they are spending less and less time with each patient so they can see more and more patients in one day.
(To be fair, so often those providers are being squeezed by practice managers and hospitals to rush patients through. I believe that most doctors, if they had a choice, would spend as much time as possible with each patient. But today there is no reality in that and no practice that relies on the reimbursement system for income can survive that.)
Further, so often the insurer dictates what can be done for a patient. The doctor wishes to prescribe this drug or this treatment – the insurer says no (or at least that they won’t reimburse for it.) The patient wishes to choose this doctor or that one – but they are not included in the patient’s insurance network.
So – back to our original question: Is there insurance reimbursement for patient advocates?
The answer, thankfully, is NO. Hell NO. NO WAY. And we don’t want insurance reimbursement! Because the minute we are required to march to the tune of the insurers, and would choose to rely on what they will or won’t give permission for, that becomes the kiss of death for our abilities to help our clients. We would no longer provide any value to them. Our practices would never survive.
The only way independent, private advocates can bring value to their relationship with their patients is if the advocate is being paid independent of the healthcare system. That may mean the patient-client pays for the advocate’s services, or it may mean a loved one, an employer, or some other payer comes forth. But in all cases, that advocate’s payer must not be one that can put any reimbursement-type constraints on the work of the advocate.
Further:
- Accepting insurance reimbursement would be a slap in the face to our advocacy ethical standards which dictate our total devotion to our clients and their needs. Dancing to the tune of the insurance drummer would violate that standard.
- Can you imagine if you needed to worry about whether or not you were included in a potential client’s network? And how many networks you would have to negotiate with each year, then accept their paltry payment offerings? Or how much you would have to pay someone to bill insurance, and how long you would need to wait to receive that payment (IF your billing was correct?)
No thanks.
Insurance reimbursement would be the death of INDEPENDENT. It would therefore also be the death of the profession of independent health and patient advocacy. And, it would be the death, debilitation, and decreased quality of life for the patient-clients we independent advocates help every day.
So, today’s message is simply this: No, independent private advocacy is not insurance reimbursable. And that’s exactly how it should be.
If a client or potential client asks you whether his insurance will cover your services, you can proudly tell him “no” and that he should be thankful it doesn’t, and here’s why….
Because now you know.
- Insurance Reimbursement for Patient Advocates?
- Why I Hope These Pigs Never Fly ? and You Should, Too
LEARN ABOUT APHA MEMBERSHIP | REASONS PATIENTS NEED ADVOCATES
I’m sure most of us will agree, this is one of the first questions we are asked. Once provided the explanation for why it’s important that insurance doesn’t pay for our services, it’s an easy segue to explain why it’s so important to have an Advocate. Great information, thank you!
Thanks Trisha. Because doctors often “dance to the tune” of the insurance company the independent, skilled advocate can often get insurance to pay for care the doctor doesn’t have time to negotiate on the behalf of the patient. In one example an advocate was able to get authorization for an Rx costing thousands and previously denied covering it. When this happens the advocate “pays their way” in a sense by getting better care covered. Your advocate is often your negotiator.
My doctor has a full time person who gets pre authorization often so the doctor can provide the treatment/Rx needed but not on the list. All this negotiating with the insurance company is paid for out of the doctor’s payment. They don’t get paid extra to advocate for you.
Hiring an independent advocate is the key. You’ve presented the issue clearly and succinctly. Thanks