What is a patient care manager or advocate? Webster’s Dictionary defines advocate as “one who pleads for another’s cause,” and a manager is defined as “to direct or carry on business.” Using these definitions, it is easy to see how a patient advocate/manager would be a great help to individuals needing to navigate our medical system.
For many, a spouse or adult child takes on this role with much success and often much frustration. In today’s complicated medical arena, the system is a labyrinth of rules, regulations, exclusions and denials over and over. When it comes to pre-authorizations and limits on patient care and treatments, insurance companies appear to be practicing medicine more than doctors. The current atmosphere has made it even more confusing with rules that seem to change daily.
Where does the patient fall into all this bureaucracy?
That’s where a patient care advocate/manager steps in to help question, clarify and stand up to insurance companies and providers for appropriate and safe care on behalf of the patient and their families.
A patient advocate sorts through all the nonsense so the patient can get the care they need. The patient is the focus, not the payment. When did that get lost? Why has it become something to accept? The manager can also direct, guide and assist in long-term planning for the patient. This role is best served by someone who is familiar with the course, understands the diagnosis and is hopeful for a positive outcome — all in the best interest of the patient.
Getting well is what health care should be — not prohibitive by the cost. Let’s focus on preventative care, not profit. That seems incongruent for a “health system” when the system does not appear to be about health. A patient care advocate/manager is almost a necessity in today’s complicated health care climate.
Here’s to your good health and staying well!
Patricia Ryan is a board-certified adult nurse practitioner and founder of Crossroads to Care in-home medical and advocacy services. She can be reached at (760) 668.1654 or www.crossroadstocare.com.