Imagine a hospital has just discharged your mother to a rehabilitation center after hip replacement surgery. She has all the discharge paperwork — and a long list of questions. Will insurance cover her entire rehab stay? Does she have enough pain medication until she gets settled? Will the hospital transfer her prescriptions? What other follow-up does she face?
Scenarios like this are exactly what patient advocates are trained to handle. They understand patients’ and families’ concerns, ensure their voices are heard by medical staffs, and interface with care teams, insurance companies and facility administrators. They also coordinate services, schedule follow-up appointments and address potential gaps in care.
I train social workers — who often serve as patient advocates — to help people in a variety of settings, including hospitals and nursing homes. Earlier in my career, I served as a professional patient advocate supporting people in hospitals, home health and hospice.
Here’s what you need to know to work with one most effectively.
What does a professional patient advocate do?
Patient advocates are trained to support, inform and guide patients through the health care system. They help explain medical information, such as a medication’s side effects or treatment options. They also make sure that patients’ questions are answered and that their concerns are addressed.
When a patient receives a referral to another provider — a cardiologist, for example, or a physical therapist — a patient advocate can connect all the points of care, making sure details about the individual’s condition or priorities don’t fall through the cracks and helping to arrange transportation to appointments.
Early in my career, for instance, I worked at a hospital with patients who were being discharged to their home or to a long-term care facility. I started by understanding each person’s goals, assessing their living arrangements and the type of care they needed and identifying any concerns they had about their discharge plan. Before they left the hospital, I coordinated community supports or additional services they might need, such as home-delivered meals, home health care and physical, occupational or speech therapy.
Patients often have family members who are advocating on their behalf — and family support is invaluable. Working with a patient advocate can provide something different: an objective perspective, expert knowledge of the health care system, and knowledge of resources that patients and family members may not be aware of.
Indeed, patient advocates interact closely with family members and friends who are involved in the patient’s care. Yet their job is to always keep the patient’s needs, preferences, goals and values front and center.
Working with a patient advocate can help patients feel more confident in making informed decisions. According to a survey published in 2023 by the nonprofit Coalition of Health Care Advocacy Organizations, 92 percent of patients and providers reported that working with a patient advocate positively affected care.
Understanding bills and insurance coverage
Managing financial aspects of health care can be overwhelming for patients and family members, particularly in the midst of a health crisis. Medical bills are often impenetrable, loaded with complex codes and terminology, and sorting through charges and details about insurance coverage can be intimidating, if not downright paralyzing.
A patient advocate can provide a knowledgeable perspective on these issues that’s not clouded by the urgency and emotional weight of illness.
Some patient advocates have specialized knowledge in medical billing, coding, insurance and other financial matters. They can answer questions about medical terms or clarify charges on a patient’s bill, review the bill for errors such as incorrect or duplicate charges, and assist with figuring out insurance coverage and reimbursement.
If necessary, they can also appeal claims by acting as a liaison between the patient and the health care facility or insurance company. They can help patients work with a hospital to set up a payment plan, explore additional financial support or coordinate access to community resources.
If a finance-related question falls outside an advocate’s knowledge or expertise, they can help the patient identify the right people to talk to.
The evolving field of patient advocacy
Patient advocacy emerged out of the civil rights movement’s focus on individual protections and rights, embracing the importance of informed consent as a way to respect a patient’s autonomy. In 2018, a professional certification was created to establish national standards for skills, ethics and knowledge across a range of medical, health care and coverage issues.
Certification is not required, and some patient advocates instead have learned relevant skills through their education or professional experiences. They may work in rural facilities, for instance, where they wear multiple hats as nurses or social workers.
Finding and working with a patient advocate
Finding a patient advocate is not always as straightforward as it should be.
If you are unsure where to start, ask to speak with a hospital social worker or case manager. In some cases, an advocate’s services are provided by the health care facility or are covered by insurance, but in others, the patient or family must pay for them out of pocket.
Even if the patient advocate is employed by the facility, coverage and eligibility can vary depending on the type of service and the patient’s insurance plan, to name two factors.
Start by contacting your local hospital or clinic and asking to be connected to their patient advocate. Alternatively, you can search for a patient advocate in your area through the Centers for Medicare and Medicaid Services website or the National Association of Healthcare Advocacy. Be sure to ask about fees or insurance coverage before agreeing to any services.
Before meeting with a patient advocate, identify your main objectives: preparing for a transition home, for example, or clarifying a treatment plan or understanding medication changes. Write down your main concerns and questions. The Care Partner Project offers checklists for questions to ask providers, prepare for doctor visits, evaluate senior living communities and more. Gather any relevant information, such as medication lists, medical records, insurance documents and medical bills.
When you meet a patient advocate with whom you’re considering working, you can feel out whether they are a good fit by asking about their professional background, areas of expertise, experience and credentials. Some questions you might start with include:
- What is your experience with cases like mine? (For example, patients being transferred to a rehabilitation center, if that is your situation.)
- Can you provide an example of how you helped a patient or family work though a difficult health care situation?
- How do you typically communicate with patients and families, and how often can I expect to hear from you?
- How do you help patients speak up about their concerns and preferences to their providers?
Finding a health care advocate you trust can make navigating a complex health situation much less overwhelming.
Jennifer Schlinger is a clinical associate professor of social work at the University of North Dakota.
This article was produced in collaboration with The Conversation, a nonprofit news organization.
The post How a patient advocate could help you navigate your family’s next health crisis appeared first on Washington Post.
