What is patient advocacy, and why is it important?

Patient advocacy plays an important role in helping patients understand their healthcare options and make informed decisions.

Read on for an overview of what patient advocacy is, what it typically looks like, and why it matters.

Healthcare providers are not always as diligent as they could be in helping patients understand the details of available treatment options. Others may not correctly follow policies or procedures, or may ignore certain rights that patients may not even know they have.

Patient advocates can help patients take a more active role in their own healthcare. They can help them understand all they need to know to make the most informed decisions possible. 

They can also handle communication with doctors, insurance providers, and other third parties on the patient’s behalf to make sure they’re being given the right information and that they understand what they’re being told.

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The medical field is large and complex. Many patients are not aware of their rights when it comes to getting the best care possible or what their options might be if they can’t get the care they need.

Patient advocacy plays an important role in improving the overall patient experience. It provides patients with as much information as possible to help them take more control of their own healthcare and make more informed decisions.

A patient advocate works closely with a patient to help them understand their options and make the best medical decisions for their situation. This person can provide patients with more information about any concerns. For example, a patient may be unsure about whether a particular treatment or medication being recommended to them is the best fit for their situation.

They also may need assistance in dealing with their insurance company if they don’t understand what they are being told or need to fix billing errors. A patient advocate can also help a patient navigate the legal process if they suspect malpractice or feel their rights are being ignored.

Working with a patient advocate allows a patient to discuss their concerns with someone who is completely on their side, especially if they feel their doctor is not listening to them. This option can increase a patient’s peace of mind and make them feel confident that they have all the information they need to make decisions about their healthcare.

Many healthcare facilities provide their own patient advocates, but patients can get in touch separately with a patient advocacy organization if they feel their needs are not being met by their hospital or other medical facility.

Many of these organizations are at least partially government funded, which helps to make sure some level of advocacy is available for any patient who needs it. Some patient advocacy organizations are focused on helping patients manage a specific illness, while others provide more general support.

Some common patient advocacy organizations are:

• Patient Advocate Foundation

• National Patient Advocate Foundation

• American Cancer Society

• Cancer Care Inc.

• National Health Council

• American Public Health Association

• Asthma and Allergy Foundation of America

• Health Advocate

• Narcolepsy Network

Most patient advocates are qualified to help patients only in certain areas. However, a strong team of patient advocates with varying areas of expertise can make sure each patient has access to the assistance they need when they need it.

Read on to discover some of the most common types of healthcare advocacy that can meet the needs of a wide range of patients.

Medical care navigation

Not every doctor makes every recommendation with the patient's best interests in mind. A patient advocate can make sure each patient is comfortable with the procedure or medication that their doctor recommends before moving forward.

Although patients would like to think their healthcare providers would only recommend exactly what they need, healthcare is also a business. Some providers may try to raise money by convincing patients that procedures or medications they do not necessarily need are essential.

Some healthcare providers may also be resistant to the idea of considering a patient’s input if a patient is interested in a particular treatment option that they did not initiate or do not typically provide. They also may not immediately listen to a patient's request to stop a particular treatment that is not working for them, causing severe side effects, or costs significantly more than an alternative they are interested in trying.

A patient advocate can help patients review their treatment options to make sure they’re moving forward on their ideal path and feel in control when it comes to making changes to treatment or medication. While following a doctor's recommendations is generally the best option, a patient advocate can step in if a patient feels that a particular healthcare provider is taking advantage of their vulnerability or pushing procedures they don’t want, instead of listening to their preferences.

Medical billing navigation

Medical billing is a notoriously complex process. Healthcare providers are not immune to making mistakes that can make it more difficult to work out what a patient owes and how much their insurance should cover.

A patient advocate can review medical bills for accuracy and help patients to fix errors before any payments are made. Not all healthcare costs are set in stone, and a patient advocate may be able to negotiate the total cost of certain procedures and fees before filing an insurance claim or paying a bill.

Although a patient advocate cannot always reduce costs as much as a patient would like, they can help to ensure the patient doesn’t pay more than they’re supposed to.

Health insurance navigation

Dealing with insurance companies can be challenging enough, let alone if a patient is unaware of their options or incapable of making their own decisions. Not all patients have health insurance, and those who do may not know exactly what their policy covers and what their rights are when negotiating treatment options and deductibles.

A patient advocate can help patients understand details of the various types of health insurance benefits they may have, such as:

• Social Security

• Veterans Affairs

• Medicare or Medicaid

• Special policies that handle vision, dental, and prescription needs

This can be particularly important because each type of program or policy can function very differently. Patients with more than one type of assistance may have a particularly challenging time navigating how their benefits from and obligations to each option fit together.

Handling more complex situations is another important task for healthcare advocates, for example, navigating insurance rights and responsibilities. Just a few areas in which a patient advocate can help are:

• Understanding the difference between in-network and out-of-network providers

• Determining what reasonable co-pays and deductibles should look like

• Knowing how to handle the appeals process if a patient’s request for a specific treatment or provider, or even their entire claim, is denied.

Patients who don’t have health insurance or are considering switching to a new provider can also get help from a patient advocate to understand the options that may be available to them and decide on the best fit for their needs.

A healthcare advocate can help each patient compare the benefits and costs of each type of health insurance they’re considering and make them aware of options they may not have heard of so they can make as informed a decision as possible.

Placement navigation

Having a medical condition significant enough to require living away from home, either temporarily or permanently, can be difficult. A patient advocate can help them evaluate their options to choose the best possible assisted-living facility, nursing home, rehabilitation facility, or other placement.

In-home placement can also be a good fit for many patients. A patient advocate can help the person decide if care at home or in a hospice, or another option, is most appropriate for them.

Navigation of older adult services

Older adults may find it more challenging to understand their rights when it comes to making the best healthcare decisions for them. They may not be aware of all the options available or may find it hard to take care of themselves and attend appointments.

Helping older adults understand their in-home care options and providing extra services they may need to live safely in their own homes will improve their quality of life.

A patient advocate can assist older adults in all these areas. They can also help older patients:

• Obtain transportation to medical appointments

• Purchase and prepare nutritious meals

• Pay for medications and treatments

• Consider in-home care options or other assistance programs to make sure their needs are met

Legal navigation

Patients may encounter a wide range of legal concerns regarding getting the treatment they are eligible for and addressing problems quickly. Making sure legal guidelines are followed properly is not always easy.

A patient advocate can help patients understand their rights when it comes to disability claims, workers’ compensation, medical errors or malpractice, being unable to access certain treatments, or other barriers to receiving the best possible medical care.

Patient advocates who are particularly skilled in handling legal issues can also take a proactive approach to raising awareness of common problems with the relevant body and working toward policy changes to make these issues less common.

Patient advocacy includes:

1. Helping patients make the best healthcare decisions for them

2. Communicating with other parties on behalf of patients

3. Furthering social justice and policy changes

A patient's nurse should be their first advocate, and doing what they can to make sure each patient's needs are being met and that they are aware of their rights should be a priority. However, nurses often have too many responsibilities to provide each patient with the level of one-on-one attention they deserve, and other patient advocates can assist patients with any areas they feel their regular medical professionals are falling short in.

Nurses should do what they can to help patients understand their medical treatment options and get them in touch with the right people to find answers if they feel that their needs are not being met.