How an Advocate Can Help You Navigate the Health Care System

A health care advocate – sometimes called a health concierge or health adviser – is a highly trained customer care professional who helps plan participants get the answers they need to address their specific health issues, often with just one phone call. 

Health care advocates do more than explain benefits, provide a new health plan ID card or indicate which care providers are in network. They can help with a wide variety of needs, such as helping people use their health benefits more effectively, understand their treatment options, estimate treatment costs and seek care for primary or preventive health issues that might have been missed.

For example, if you call an advocate about covered treatments for your back pain, they might notice your high blood pressure. They can recommend a diabetic screening with your primary care doctor, refer you to a tobacco-cessation program or even remind you to get a flu shot, if needed. Often with just one phone call, you may be off to a great start on getting healthier.

Hospitals have offered patient advocates for years. In the past decade, private medical advocates have become more popular, but their services may cost up to $300 an hour. Now, some of the nation’s largest insurers provide these services as part of their health benefit plans, and their work often helps both employers and employees see medical cost savings.

If you don’t already have an advocate benefit, consider this service before open enrollment this year. Asking these questions may help you understand the level and type of advocacy services offered when choosing a health plan for you and your family:

  • What types of services are available? Determine if the health plan’s customer service representatives provide help with not only enrollment, billing and care provider networks but also with specific health issues that enable you to navigate the health system and seek the right care at the right time.
  • Who has access to advocacy services? Some health plans offer advocacy or concierge services only for plan participants with complicated or chronic conditions. Other health plans offer services to all eligible plan participants as part of their coverage.
  • How convenient are the advocacy services? How does the health plan handle high call volume? Will service representatives or advocates have access to your records? Health plans that invest in the latest technology put resources at advocates’ fingertips and aim to resolve your questions in one call. If they can’t, they should be able to provide a time frame when you’ll have answers. They also should commit to resolving your issue completely, no matter how long it takes.
  • What training have advocates received? Many advocates are nurses or other experienced medical professionals who receive extensive training. They are trained to provide compassionate, personalized attention – and turn to doctors, pharmacists and disease-management specialists who can address your specific needs.

Ultimately, advocates can help people identify what questions to ask, learn what services are available for a new or complex diagnosis and encourage patients to seek preventive care to help avoid certain symptoms from becoming serious health issues. Advocates also may help people feel more satisfied with the health benefits they receive. 

Health advocates are committed to helping people navigate the health care system and addressing complex health issues. Advocates are an exciting new way for health plans to provide personalized support and connections to help people improve their health and quality of life.