The Question of Insurance Coverage for Advocacy Services

Posted on April 18, 2022

Are the services of an Independent Professional Patient Advocate covered by insurance companies? The short answer is – No. Nor do we want insurance reimbursement. If we did, then we would be working for the insurance company, not for you - the client/patient or family. Let me explain.

As Independent Professional Patient Advocates, we are invested in the care and outcomes of our patient/client and their family. This means each client is the priority, period. We focus on the needs and priorities of each client, easing the burden of the health care experience to assure the delivery of optimal care and favorable outcomes.

During the last two decades, I have witnessed the subtle decline of care and concern at the patient’s bedside. One evening years ago while working on a hospital medical surgical unit, Dr. J arrived to check in on his surgical patients.

Of the 7 or 8 patients he visited that evening, one encounter is worth sharing to illustrate this point. While greeting the elderly female patient, he comfortably sat down beside her (yes, on her bed – now, absolutely unheard of). Dr. J kept the conversation going while checking her surgical dressing, and listening to her breathing and heart rate. While discussing her upcoming discharge (yes, the patient and physician actually having a conversation), he noticed a box of chocolates on her bedside stand. He helped himself, much to the delight of the patient.

Contrast that to a similar bedside visit today. Physician enters the room, sometimes accompanied by a nurse or other member(s) of the care team, most often (but not always) acknowledging the patient, and a loved one if present, but rarely making eye contact. He assesses the patient, asking questions where a yes or no response is expected. He completes the visit while checking the appropriate boxes on his tablet and asks if there are any questions just before, or upon as exiting, the room.

Your physician is in a hurry because everything he does during the visit (exam, ordering labs and other tests) is paid for by insurance companies at a rate set by the insurance companies. Doctors are paid per patient, and the more patients they see in one day, the more money they make. They are NEVER reimbursed for the TIME spent with each patient, so things like having a conversation, providing explanations, or answering your questions have fallen by the wayside.

Enter the professional patient advocate. Our value comes from our relationship with you. Our loyalty is to your needs, and by focusing on your needs we ease the burden you experience while navigating our ever-more complicated healthcare system. Our value comes from being independent of the healthcare system – while having deep knowledge of every facet of the inner workings of that system.

To be reimbursed for client services through insurance companies would force us to adhere to their assessment of what the client needs, including what they will, or will not, pay for and how much. As a result, the insurance company defines the care…not the needs of the individual client.

An Independent Professional Patient Advocate will always keep you, or your loved one, the priority in your healthcare journey.