What is an Independent Patient Advocate?

An Independent Patient Advocate is a healthcare specialist who helps patients and their loved ones navigate the challenges and complexities brought about by a medical system that is overcrowded, expensive, and often dangerous. Independent Patient Advocates come from diverse backgrounds with different skillsets. Many are former healthcare professionals who know the “ins and outs” of the medical system. Others have experience in billing, insurance, caring for aging adults, or as mentors for people living with disabilities or chronic illnesses.

Independent Patient Advocates undertake coursework, mentoring, training, and continuing education to gain the skills to successfully improve patient outcomes. A substantial number of advocates have been tested, credentialed, and certified as Board Certified Patient Advocates (BCPA) by the Patient Advocate Certification Board (PACB). In addition, Every advocate listed in the Greater National Advocates directory has agreed to abide by the Ethical Standards of The Patient Advocate Certification Board.

What are the benefits of working with an Independent Patient Advocate?

Independent Patient Advocates are in private practice, working directly for patients and their loved ones, they are free from many of the internal restrictions that often limit the time and resources available for doctors, nurses, and clinicians to provide safe, individualized, and coordinated care. Although many hospitals and healthcare institutions employ their own so-called patient advocates, they are beholden to the restrictions placed on them.

Independent Patient Advocates work one-on-one with patients and loved ones to oversee care, explore treatment options, and improve communication with overworked hospital staff. A professional Independent Patient Advocate has the knowledge, experience, and training to step in, listen, gather information, identify areas of concern and take charge by recommending the best plan of action. In fact, many Independent Patient Advocates used to work for hospitals and health care companies before they decided to work directly for patients.

What is the role of an Independent Patient Advocate vs. a Hospital-Employed Patient Advocate?

An independent patient advocate is a professional who works on behalf of patients to help them navigate the healthcare system and advocate for their needs and rights. They may provide a variety of services, including helping patients understand their diagnoses and treatment options, communicating with healthcare providers on the patient’s behalf, and assisting with insurance and billing issues. Independent patient advocates are typically not affiliated with a specific hospital or healthcare facility and may work with patients at multiple facilities.

In contrast, a patient advocate who works for a hospital is an employee of that specific hospital. Their primary role is to assist patients and their families with any concerns or issues they may have related to their care at that hospital. They may also be responsible for helping patients understand their rights as a patient and advocating for their needs within the hospital. Patient advocates who work for a hospital may have more limited scope in terms of the services they can provide compared to independent patient advocates, as they are typically bound by the policies and procedures of the hospital where they work.

Who pays for Independent Patient Advocate services?

Health insurance generally does not cover independent patient advocates because they are not considered to be medically necessary services. Independent patient advocates are individuals who help patients navigate the healthcare system, advocate for their rights, and ensure that their healthcare needs are met. They can be helpful for patients who are facing complex medical situations or who may need assistance in communicating with their healthcare team. However, because these services are not directly related to the medical treatment of a specific condition, they are not covered by most health insurance plans.

It is worth noting that some health insurance plans may offer certain advocacy services as part of their coverage. For example, some plans may provide a patient advocate who can help with insurance-related issues or can provide guidance on navigating the healthcare system. However, these services are typically provided by the insurance company itself or through a contracted provider, rather than an independent patient advocate.

If you are interested in hiring an independent patient advocate, you may need to pay for their services out of pocket. Some patient advocates may offer sliding scale fees based on your income or may offer discounts for certain groups, such as seniors or military veterans. Alternatively, you may be able to find a patient advocate who is willing to work on a pro bono basis or who will accept payment in the form of trade or other non-monetary compensation.

More and more employers are including Employee Assistance Programs (EAP’s) as an employee benefit. These programs may pay for Independent Patient Advocacy in the event of a medical emergency. These programs usually also cover the spouses of employees. You should check your employee handbook or inquire with your company’s benefits team to see if there in an Employee Assistance Program in place.