BILLING & CLAIMS

Review of medical billing and charges to ensure accuracy in billing.

  • Seek billing reduction and/or negotiation
  • Resolve billing errors

CANCER

Some advocates specialize in navigating in cancer, cancer-related issues, specific cancer types (like brain cancer) and/or helping clients find and participate in cancer research.

END OF LIFE / LIFE CARE PLANNING

  • Helping clients understand and plan for transitions and end of life
    • Advanced care directives
    • Burial/cremation
    • Hospice services

HEALTH COACHING / PREVENTION SERVICES

Assisting clients in ways that further personal health goals and ensure better health outcomes through preventative measures.

HEALTH INSURANCE

  • Identify sources of coverage for people without insurance 
  • Confirm and decipher coverage for those with insurance coverage, including
    • ​Medical Benefits
    • Pharmacy Benefits
    • Vision Benefits
    • Medicare Benefits and Supplements
    • Home Health and Rehabilitation Coverage
    • Social Security
    • Veterans Benefits
  • Explain patient costs such as co-pays and coinsurance
  • Facilitate research for appropriate in-network providers and clarify out-of-network options and costs
  • Advise on denials and appeals processes
  • Help with choosing health plans, Long Term Care plan or COBRA (continuation of benefits)
  • Investigate additional benefits available such as private or employer-provided disability or long-term care insurance
  • Exploring appropriate Wellness benefits:
    • ​Preventive Care
    • Alternative Care
    • Member Discounts
    • Use of Advice Lines
    • Hearing Aids and Screening

HEALTH CARE PROXY

An advocate can serve as a health care proxy (medical decision-making surrogate) to make decisions for when someone is unable to make decisions for themselves;  a health care proxy is named in a durable power of attorney for healthcare and needs to be evaluated whether the person can serve in that role.

MEDICAL / NAVIGATIONAL 

Typically includes interacting with healthcare professionals, attending appointments, medical translation, appointment setting and coordination, asserting client’s patient rights, communication, identification of medical/health resources, etc. 

  • Help patients understand their diagnosis and learn more about their condition
  • Translate complicated medical information for family members
  • Research treatment options
  • Coordinate care between various physicians
  • Provide regular contact with patient to evaluate condition and advocate for appropriate care with providers
  • Assist with transitions including hospital admissions, stay and discharge; transfer to another facility, care center or home
  • Coordinate outpatient care
  • Help with understanding and managing chronic disease
  • Establish contact with Social Service Programs and Eldercare
  • Act as liaison between patient and with providers regarding wishes for hospice
  • Referrals to appropriate resources as needed
  • Assist with communications with providers, family members at client’s patient’s direction

MENTAL / BEHAVIORAL HEALTH & SOCIAL WORK

  • Managing stressful, serious, and/or chronic health conditions
  • Issues related to controlled substances
  • Working with behavior health challenges that make communication difficult 

OLDER  ADULT  SERVICES

  • Housing
  • Home care or support
  • Transport
  • Meals/nutrition
  • Treatment plan assistance i.e. medications, lifestyle changes
  • Financial

PAIN MANAGEMENT / PALLIATIVE CARE

Helping clients ensure that their pain is managed appropriately, whether short-term, long-term, and at the end of life​.

PEDIATRIC CARE

Working with families whose children need support in navigating various aspects of the health care system.

TRANSITIONS / HOUSING PLACEMENT 

  • Transitions in/out of hospital, assisted living, skilled nursing, nursing home, adult family home, or other placement, including home with or without care