The usual story that people get told about healthcare is this:
But we all know it’s more nuanced than that. Here at Health Benefits Now, we’re demystifying healthcare one article at a time. And today we’d like to shed light on something they don’t normally tell you about healthcare and insurance:
What’s A Healthcare Advocate?
Healthcare advocates (sometimes referred to as patient advocates) focus on reducing a member’s out-of-pockets costs when it comes to medical bills. Depending on the advocacy program, they can assist self-paying patients as well as those with insurance. In short, they help patients navigate the healthcare system so they receive the most reasonable bill (if any) at the end of the day.
How do they do this? Advocates are trained in the in and outs of the healthcare system and use their direct contacts at hospitals and carriers to represent their clients’ cases. They collect paperwork about how much the member makes and how much coverage (if any) they already have. As you’ll see below, there’s plenty of loose interpretation in insurance policies--and advocates work to make that interpretation come out in their clients’ favor.
It’s important to note that healthcare advocacy programs are NOT insurance. Yes, you pay a monthly fee, and yes, you can receive discounts on hospitalization. However, healthcare advocates work with those who have little, no, or lapsed insurance--and they don’t “share risks” like an insurance company is designed to do.
You might be asking at this point: Ok, then what’s the point? Why pay extra, especially if I already pay for insurance?
To answer that question, we’re going to take a brief pit-stop and talk about insurance contracts. Even if you are currently uncovered, it’s good to know how to interpret the fine print:
Medical Emergencies: The Usual, Customary, and Reasonable Charge
Ask yourself this: What constitutes a medical emergency? For you, that might be anything that leads to an unforecasted visit to the doctor or ER. It could be a broken arm or the swine flu or a sudden deadly allergy. Either way, it was unexpected and it wasn’t from any type of negligence on your part, and now you’re stuck with the co-pay (or worse) on your medical bill. Surely, this is a medical emergency.
But neither you nor your doctor are the ones interpreting what constitutes a medical emergency. That responsibility belongs to somebody you’ve never met who happens to work in your insurance carrier’s office. And they’re looking at your insurance contract, which is talking less about “emergencies” or more about what those “emergencies” cost.
Because it’s also neither you nor your doctor that get to interpret what a “usual, customary, and reasonable (UCR) charge” amounts to. You racked up four days and three nights at a hospital (like our pal Steve below)? And it costs $12,000? Your insurance carrier could very well state that this is not usual, not customary, and not reasonable. Because who else has a say?
So, their UCR charge? Say they pick $7,000. Know what that means? You’ve got a cool five grand to come up with. Sure, this was an emergency, but in their book it wasn’t that kind of emergency!
Good News: We aren’t about to tell you that insurance companies are never there for you (we wouldn’t be in this business if we thought that), and, to reiterate, you do have an advocate on your side.
Just take a look at Steve’s story down below to see how healthcare advocacies have worked miracles:
Back in 2012, Steve was self-employed and working a non-salaried position at a Fortune 500 company. The position was seasonal, eight months out of the year, to coincide with football’s pre-, mid-, and post-season. At the time, the job did not offer year-round benefits.
Steve was going on his third year with his company. He was married, didn’t have any dependents to worry about, and was used to weathering his lapse in coverage in the off-season between January and May. After all, so far, so good.
It happened in February 2012--a whole four months before Steve was set to be covered with Fortune 500 premium benefits. A sudden bout of pancreatitis landed Steve in the hospital for a total of 4 days/3 nights, which created just over $12,000 in medical bills.
What was Steve going to do? He wasn’t covered through his entrepreneurial business, and he’d just been clocked off his seasonal benefits at work.
There was one teeny change that Steve had made in his healthcare. It just so happened that 2012 was the year that he picked up a healthcare advocacy program.
One week and a bit of paperwork later, and his particular healthcare advocate was able to verify that he had a source of income but was financially unable to pay for his medical bill--and that same advocate was then able to knock off everything.
Now, this is NOT a guarantee that this happens every time. But if you look up “miracle worker” in the dictionary, we wouldn’t be surprised if a patient advocate’s portrait showed up.
So, how can an insurance agency help you find out more about healthcare advocacy?
For that, you just request a free quote.
Already covered by an insurance carrier? No problem--we can still look into adding an advocacy program to your custom healthcare plan.
It takes five minutes to get a quote, and all the information you get is free.
What are you waiting for?