Considering she is a physician, she may indeed have more clout than other employees. That said, I’d communicate directly with the HR Department for assistance, in consideration that since COVID many therapists stopped face to face appointments, and others stopped practicing.
That said, if there were limited providers available, or not accepting…[Read more]

Looking forward to this seminar, not only from a personal standpoint as a Cancer Club member, but also in my work as a patient navigator for cancer patients.

Thanks AnnMarie! Good luck with the appeal.

Gayle,

We have been successful with two different clients getting coverage retroactively for private duty nursing. Like you, I was able to prove that there were no in-network options at the time that the nursing commenced and that seemed to do the trick. In both cases we also argued that the extraordinary medical needs of my clients (their…[Read more]

Hi Kathleen!
While I do not have a Policy & Procedure Manual geared toward policies for an RN Advocate, I am currently developing my own manual and would be happy to talk through the process with you!

I will send you a direct message to connect!

Christie – it’s a good question because they are both about privacy. But HIPAA and GDPR are actually as different as horses and zebras.

HIPAA is US Federal healthcare law. Health Insurance Portability Accountability Act. Notice Cindi’s explanation is spot on – that is – as advocates (to date) we as independent advocates are not beholden to HIPAA…[Read more]

What is GDPR?

First, congratulations on your new business!

I will caveat this clearly that I am not an attorney, but have had this conversation with several healthcare attorneys. It’s very important to remember that if you are not a healthcare provider, a healthcare payer, or a healthcare clearing house for payment, you are not a covered entity under HIPAA.…[Read more]

Also, on a more granular level—I think all of us as patient advocates have dealt with poorly trained office staff for providers. Quite often the office staff has never worked in health care–the provider never spends the money to have them trained (and sometimes does not care to do so).

I personally had a claim denied b/c the office staff…[Read more]

Christie – you’ve got this! Well done. Does my marketer’s heart good….

I like that you lead with the benefits, and the resolution to their FUDGE.

Thanks for sharing!

ROUGH DRAFT:
I am trying to reach their pain points and frustrations then outline the benefit of working with me.

Desired niche (I know I will need to be more general initially):
Fellow chronic illness sufferers, including EDS, MS, Lupus, and other invisible and difficult to diagnose disorders where it is hard to find and prepare for medical…[Read more]

Most in network providers are set up for electronic claims processing. In addition to submitting claims on line, this also allows them to do a benefits check and, based on claims in the queue in front of them, have an electronic communication of the patient’s responsibility. If this provider is truly a contracted provider with the patient’s…[Read more]

Steph – you really did a great job with this, and while I’ll answer some of your questions here, when we do our live class today, you’ll learn a bit more nuance – and you’ll be able to adjust accordingly 🙂

If I make it sound easy it’s because this info is so basic. It can become very complicated as you drill down. But if you stay with the…[Read more]

Hello!

Trisha, you make this sound so easy! I hope this will get easier with practice 🙂

I am not exactly sure that I am doing this assignment correctly, but here goes!

Task 1:
List of people who may hire us:

Patient (any age): Going through FUDGE. They could be patients at high risk, complex diseases, maybe new to the area and looking for…[Read more]

Just chiming in with another tip that’s worked for me and that’s verifying that the doctor has received the actual payment from insurance. If they have received the payment in full from the patient and received the insurance payment it can be viewed as fraud. Hopefully the office will either credit the client’s account or issue a refund. Latel…[Read more]