What to Look For in a Private Healthcare Advocate

by Joanna Smith on May 28, 2009

Are you Considering Hiring a Private Healthcare Advocate? Here are some guidelines to help you with your selection:

1. Consider the services you most need help with. Are you going into the hospital? Are you considering a second opinion? Do you need help finding community resources? Are there insurance issues? Pick the professional with the training to help you with your particular needs.

2. If you need help with medical decision-making, choose medical professionals with degrees in social work, nursing, health education or related fields.

3. Choose someone with experience in both in-patient and out-patient settings.

4. Ask if your Advocate works alone or with a team of professionals.A team approach offers more services and expertise to help you.

5. Do they have experience in working to resolve insurance issues? Do they know how to file appeals? Negotiate with the insurer?

6. What is their area of specialty:do they work with newborns and children? Adults? Seniors?

7. Do they have specific experience with your particular condition?

8. Do they provide in-person services?In a crisis, a telephonic-only system can be impersonal and difficult to navigate.

9. Ask about their business relationships:do they also work for an insurance company? A hospital? Do they accept paid advertising on their web site? Do they receive bonuses for referrals to certain services? A private healthcare advocate should have not conflicts of interest:you need to be assured that they are working only for you.

10. If they are licensed, check with their state licensing board to verify that their license is clear and valid.

11. Do they bill by the hour? By the month? Is payment due at the time of service or do they do monthly billings? Do they ask for a minimum commitment of hours per month? Do they have policies and procedures clearly spelled out including fees, methods of payment, what to do in an emergency and medical record confidentiality?

12. What are their policies on termination of services and complaint resolution?

And, most importantly, are they a “good fit” someone you feel you’d be comfortable working with under stressful situations?

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