Living with Chronic Pain
Types of Patient Advocacy
What is patient advocacy?
Patient advocacy is defined as protecting the interest of a patient through various means, including defending their rights, protecting them against inadequate health care, providing support (e.g., financial, legal, emotional, etc.), and contributing to health care decision-making. A patient advocate may also provide caretaking, assist in the navigation of the health care system, and promote patient protection.
Types of patient advocacy
Patient needs determine the type of patient advocacy required. Patient advocacy comes in many forms with different expertise and skills. Types of patient advocacy include, but are not limited to, the following:
Medical or navigational advocates can provide the following:
- Ensure patients understand their diagnoses
- Research and communicate treatment options
- Interact with health care professionals
- Translate medical information to patients and their families
- Act as liaisons between various health care professionals
- Arrange appropriate care with providers
- Coordinate outpatient care
- Provide resources
- Establish contact with social service programs
- Assist with hospital admissions, stays, transfers and discharges
Medical facility advocacy
Medical facility advocates, such nurses or social workers, act as mediators between patients and their attending physicians. They ensure patients have safe accommodations, self-care instructions, potential treatment avenues, and accurate diagnoses. They also resolve any potential patient issues through communication with the physician and medical facility staff.
Billing and claims advocacy
Billing and claims advocates ensure billing is accurate, help resolve any billing errors, and negotiate billing reduction.
Health insurance advocacy
Health insurance advocates assist patients with benefits (e.g., medical, prescription, vision, Medicare/Medicaid, Veterans Affairs, Social Security, home health, etc.). They also assist individuals without health insurance in selecting health coverage. Health insurance advocates also conduct and communicate research to patients regarding in-network and out-of-network providers, co-pays and coinsurance, denial and appeal processes, wellness benefits, and additional benefits that may be available.
Family advocates represent patients’ families by mediating conflicts between patients and their family members regarding medical treatment decisions. They also provide resources to help the family.
Legal advocates assist with legal matters such as workers compensation, disability claims, or malpractice and medical error reviews. They can offer legal advice, provide payment solutions, and petition on a patient’s behalf if a needed medication or treatment option is legally restricted. Some legal advocates also campaign for policies or laws that improve health care systems and processes for patients.
Administrative advocates ensure medical records are transferred correctly and arrange health care provider appointments. They may also arrange or provide transportation as needed.
Medical tourism advocacy
Medical tourism advocates assist patients when travel is required to receive health services. They may also help with international travel for a variety of health care related concerns (e.g., costs, medical service referrals, procedures not offered in country of residence, treatment combined with vacation destination, etc.)
Health coaching and prevention service advocacy
Health coaching and prevention service advocates assist patients in improving future health outcomes through preventative measures. This could include proper nutrition or physical activity recommendations.
Transitions and housing placement advocacy
Transition or housing placement advocates help patients with transitioning in and out of hospitals or medical facilities. They can also help with transitioning to assisted living facilities, nursing homes, skilled nursing facilities, adult family homes, or other placements.
Older adult services advocacy
Older adult service advocates assist patients that need housing, transportation, meals, treatment plans, and medications. They can also arrange in-home care and financial assistance.
Mental and behavioral health and social work advocacy
Mental and behavioral health and social work advocates help patients manage stressful health conditions, addiction issues, and problematic communication due to mental or behavioral challenges. They can also work with patients concerning appropriate medications and therapies.
Pain management/palliative care advocacy
Pain management/palliative care advocates help ensure a patient's pain is managed properly. This may include recommending a change in the dosage or type of medication.
End-of-life advocates can help patients understand and plan for the end-of-life transition. This may include help with advanced care directives, hospice services, and burial or cremation.
Most patients do not need all types of advocacy, and most advocates are not qualified to provide all types of assistance. However, finding the right person or people to assist leads to the best outcomes for patients and their families.