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How an Advocate Can Help You Navigate the Health Care System

Imagine this scenario: You’ve had low-back pain on and off for several years. You’ve tried ignoring it, practicing yoga and taking over-the-counter medications to reduce the pain. Yet the pain keeps coming back, and this time your toes are tingling, too.

Should you see your primary doctor or go to urgent care? Will you need physical therapy or even surgery? Will your health plan help cover the treatments you need?

Help may be as close as a one-on-one interaction with an advocate. Better yet, this help may be available from your health plan at no additional cost to you.

 

A health care advocate – or a health concierge or health adviser – is a highly trained customer care professional who provides personalized service that 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 your benefit plan’s care provider 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 can cost up to $300 an hour. Now, some of the nation’s largest insurers provide these services as part of their health benefit plans.

During open enrollment this year, consider the level and type of advocacy services offered when choosing a health plan for you and your family. Asking these questions can help you understand your options:

  • 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 primary and preventive care to prevent certain symptoms from becoming serious health issues. Advocates also may help people feel more satisfied with the health benefits they receive. For example, UnitedHealthcare reports that more than 95 percent of plan participants surveyed said they are satisfied with its advocate program.

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.