What Is a Patient Advocate, and How Can They Help Me?
Key takeaways:
Patient advocates can help you navigate the healthcare system by guiding you to find the best care for your current medical issue.
You can find a patient advocate either on staff at a medical facility or privately as independent contractors or small businesses.
Patient advocates may save you time and money and help you get answers to serious medical questions.
Navigating the U.S. healthcare system can be scary and confusing. You may ask yourself, “Am I getting the best care for my current medical need?” or “Should I get a second opinion?” You may wonder if a prescribed treatment is necessary or if an expensive prescription is worth the price. You might even struggle to understand your medical bills or wonder how you’re going to pay for therapy.
At times like these, you could use a champion — someone to support you through your healthcare journey. That someone goes by the title “patient advocate.”
Patient advocacy is a growing profession in the healthcare industry, but the concept has been around since the 1990s. That’s when Dr. Harold P. Freeman, a surgical oncologist in Harlem, New York, promoted patient advocacy as a means to break barriers between underserved communities and cancer screenings. As the healthcare system has grown more complex, the need for advocates has also grown.
Here we’ll cover what services patient advocates provide, how to find a patient advocate, and other advocacy options.
What is a patient advocate?
A patient advocate is a trained professional who helps guide you (or your loved one) through the healthcare system. They may use different titles such as:
Health advocate
Patient or health navigator
Care or case manager
Ombudsman
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No matter what they’re called, they work toward the same goal: to help you get through your healthcare journey from screening and diagnosis to treatment and follow-up care. In fact, patient advocates can do anything from solving a billing problem to sitting with you daily during a hospital stay.
Make medical appointments for visits, tests, treatment, or therapy
Pull together financial and legal resources
Find you social support such as support groups or local agencies
Work with your health insurance plan to cut your medical costs
Communicate with your healthcare provider’s case manager
Resolve conflicts between you and your health plan or healthcare provider
Explain medical bills
Gather information and go over healthcare options with you
Set up second opinion appointments
Save you money by spotting mistakes and negotiating medical bills
What kind of questions can a patient advocate help you get answers to?
Many patient advocates earn certifications, and some have worked as registered nurses, social workers, or health plan administrators. That combination of training plus experience makes them experts at digging for answers to questions such as:
Where will I be going for care, and what transportation options do I have?
Who do I contact if I need care in the evening or over the weekend?
Can you tell me more about my healthcare issue (e.g., cancer, diabetes, torn meniscus, etc.)?
Can you tell me more about my treatment options?
Who can I talk to when I feel overwhelmed?
How can I get financial assistance for my care?
Can you explain my medical bills to me?
How long do I have to wait for my next appointment?
I’m not happy with my care. Can you help me find a different provider?
When can I go home?
Do you always always need a patient advocate?
Not necessarily. You probably don’t need a patient advocate if you’re able to process medical information and make informed decisions about your care. A supportive partner, family member, or friend may also negate the need for an advocate.
You or your caregiver must be willing to speak up, question the system, and understand your rights. If you’re confident and up for the challenge, you can advocate for yourself. And you can always seek the support of a patient advocate further along in your journey should the need arise.
How can you find a patient advocate?
You don’t have to look far to find a patient advocate. Some advocates are on staff at medical institutions, while others are volunteers at non-profit organizations. You can also find advocates in private practice.
Unless you really want to meet in person, you can communicate with your advocate through an app, text, email, video chat, or a patient portal.
These resources can help you start your search:
AdvoConnection. This directory connects you with self-employed individuals or small businesses offering patient navigation services in your area. Private advocates charge hourly fees or a flat fee.
National Association of Healthcare Advocacy (NAHAC). The NAHAC directory can help you find an advocate by location, area of expertise, or both.
Patient Advocate Foundation (PAF). PAF offers free case management services to people or caregivers living with one of the serious or chronic health conditions listed on their website.
Hospitals. Many hospitals have advocates on staff who handle complaints and grievances for inpatient hospital stays. You won’t pay extra for a hospital advocate and they’re often available to you after you’ve been discharged as well.
Senior living facilities. Nursing homes and assisted living communities often have advocates on staff to help resolve problems for residents or their caregivers. Their services are included as part of your fees.
Health plans. Your health insurer may offer you a case manager who is a social worker or registered nurse. You may want to ask your plan for their limitations, such as how often you can contact your advocate or if their services expire after a certain period of time.
Employers. Ask your employer if they offer patient advocacy services as part of their benefits package.
What other advocacy options are available?
As mentioned above, you may not need a patient advocate if you or your caregiver feel comfortable speaking up and handling the healthcare system on your own. Self-advocacy is certainly one way to be heard, communicate your needs and expectations, and express concerns. Here are two more options to consider:
Community health workers (CHWs). CHWs assist in community healthcare settings by representing underserved individuals, educating the public on health topics, and supporting social services. Because of their involvement within communities, they often advocate for those who don’t have the resources to speak for themselves.
GoodRx Patient Advocacy Team. GoodRx has a support team available to take your calls about more than just drug prices. Team members can answer questions about copay cards, pharmacy memberships, and other prescription-related topics. Call 888-799-2553 with your questions.
The bottom line
Patient advocates help people who can’t or don’t feel comfortable speaking up for themselves within the healthcare system. They provide services such as coordinating medical visits and treatments, negotiating medical bills, and arranging for second opinions or follow-up care. They get answers to questions you may have about therapy, transportation, and prescription medications.
Whether you get support from a volunteer advocate, a hospital care manager, or a private patient navigator, they all work toward the same goal: making sure you get the best care possible.
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References
AdvoConnection Directory. (n.d.). Advocacy and care management services.
AdvoConnection Directory. (n.d.). AdvoConnection directory.
Alliance of Professional Health Advocates. (2020). An overview of the profession of health and patient advocacy.
Freeman, H. P., et al. (2011). The history and principles of patient navigation. Cancer.
Georgetown University Medical Center. (2017). Dr. Harold P. Freeman to receive Cura Personalis award.
Health Net Federal Services. (n.d.). Hospital patient advocates are there to help you.
Kaiser Permanente. (n.d.). Complex case management / gender health referrals.
National Association of Healthcare Advocacy. (n.d.). Find an advocate.
National Association of Healthcare Advocacy. (n.d.). National association of healthcare advocacy.
National Long-Term Care Ombudsman Resource Center. (n.d.). About the Ombudsman program.
Oluwole, S. F., et al. (2003). Impact of a cancer screening program on breast cancer stage at diagnosis in a medically underserved urban community. Journal of the American College of Surgeons.
Patient Advocate Certification Board. (n.d.). Patient advocate certification board.
Patient Advocate Foundation. (n.d.). PAF.
Patient Advocate Foundation. (n.d.). PAF case management.
