What Is the Role of a Patient Advocate?

senior woman signing document

Patient advocacy tends to be seen as a growing trend, but in reality, the profession has been around since the 1990s. Dr. Harold P. Freeman, a surgical oncologist in Harlem, NY, developed patient advocacy to break barriers among underserved areas and cancer screenings. As the healthcare system has become more complicated, there are still those who stand up for struggling patients.

What Is a Patient Advocate?

A patient advocate goes by many names, but they all have one goal: to help guide you or a loved one through the healthcare system, from screening and diagnosis to treatment and follow-up care. Patient advocates are commonly referred to as:

  • Health advocate
  • Patient or health navigator
  • Care or case manager
  • Ombudsman

No matter their title, they will help the patient in need with:

  • Accessing the necessary health care
  • Educating all parties so they can make well-informed decisions
  • Guiding patients and loved ones through medical care and insurance questions
  • Help with administrative and legal tasks

Is There a Difference Between Hospital Advocates and Independent Advocates?

A patient advocate helps patients navigate the healthcare system and ensure they receive the best overall care. At some hospitals, they have their own patient advocate on hand. This could include a social worker or chaplain to better understand what's happening for them during an illness/injury process.

Other staff members may also play integral roles in advocating for those they serve, such as nurses. Their job duty includes following up after procedures have been completed and educating new hires on the medical needs of patients currently receiving care.

However, there are times when patients and their families feel the need to hire an Independent Advocate. According to advoconnection.com, "In most cases, the hospital’s patient advocate works for the Risk Management Department of the hospital...when an advocate is employed by a hospital, or by an insurance company, and because they have a financial stake in your care, then they cannot and will not be able to provide all the help you need because their allegiance is to their employer."

Some enjoy the security an Independent Advocate gives them as they know that their allegiance is to the patient in need of help, instead of the hospital, as you employ them.

What Do Patient Advocates Do?

what do patient advocates do

Patient Advocates will help will a myriad of tasks, including:

  • Setting medical appointments for visits, tests, treatment options, or therapy
  • Help to locate financial and legal resources
  • Connect you with local support groups and/or agencies
  • Work with health insurance providers to cut costs
  • Communicate with the healthcare provider case manager
  • Resolve conflicts pertaining to health plans or healthcare providers
  • Simplify complex medical bills
  • Go over healthcare options
  • Schedule appointments for second opinions
  • Save money by identifying errors within medical bills
  • Negotiate medical bills

While all components are essential, four significant elements of their advocacy need to be explained further.

Support with Healthcare Visits

Everyone has dealt with the frustration of not understanding what a doctor says, especially if they are one of many components of your health care team. The feeling can worsen when you feel they are rushed to move on to other patients. Patient advocates are here for just this purpose: helping patients make sense of medical jargon and get their needs met after each appointment with their physicians.

Some patient advocates provide support by prepping you or your family member on the questions and concerns you have before your appointment, but others will come with you to take notes that you can review later and/or help you ask the right questions while you have your doctor.

Help in Understanding Medical Bills

Medical billing is a complicated system that can lead to mistakes. Healthline claims up to 80% of all medical bills in the U.S. include errors. Patient advocates help you through the complex task of identifying parts of your medical bills that may be incorrect and help offer clarification of details that may not be understandable to you or your loved one.

Deal with Healthcare Insurance

Patient Advocates are there to help their patients understand what they need to know about insurance coverage. They will explain how their policy works and offer clarifications on coverages, exclusions, premiums and/or co-pays for doctor visits based on that specific plan’s requirements.

Some patient advocates work closely with healthcare financial departments, billing insurers when necessary, so all parties get paid quickly after rendered services.

Navigate Legal Situations & Uphold Patient Rights

Patient advocates help their clients navigate the confusing healthcare web, ensuring that providers and insurers provide proper care. They will identify gaps in patient coverage or concerns about how they're being treated and take action accordingly.

Where Do Patient Advocates Work?

Patient advocate professionals can be found in many different places throughout the healthcare industry. They are not limited to one work setting. Some areas of employment include:

  • Insurance companies
  • Government agencies
  • Patient-focused firms
  • Private patient advocate (self-employed)
  • Hospitals
  • Nursing homes

Who Needs Patient Advocates?

Some may not require a patient advocate. This is especially the case if you can make informed decisions regarding you or your loved one's care. However, an advocate is needed when a patient has trouble understanding or remembering important information and/or communicating relevant views, wishes, feelings and beliefs.

How Do You Find a Patient Advocate?

how do you find a patient advocate

For some, patient advocates with the proper expertise can be challenging to find; however, there are sites out there that can help alleviate the stress of locating the appropriate advocate for your situation.

A list to ask your potential patient advocate includes:

  • Have you handled similar cases?
  • Do you specialize in one area such as insurance or billing?
  • What is the cost of your services?
  • Do you have references I can contact?

How Do You Become a Patient Advocate?

A career in patient advocacy is a growing occupation. You don't need formal education requirements for a career in patient advocacy, but some degree programs can help you get the relevant experience necessary for success. Examples of these degree programs include:

Is a Patient Advocate Always Necessary?

No one should have to go through the medical system alone, and everyone should have access to the best care possible. A professional patient advocate can help with everything from making sure medications are administered correctly, providing emotional support and guidance, and advocating on your behalf if something goes wrong during treatment. For more info, check out MIP Cares' website.