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Easing pains of health care, for a fee

Dr. Maura Shea examines patient Michelo Cineas at the Codman Square Health Center in Dorchester, Mass.

TEXT OF STORY

KAI RYSSDAL: Every time I have to open one of those envelopes from my health insurance company a little chill goes down my spine. Because I know that inside there's one of those "explanation of benefits" letters -- which more often than not launches me on a voyage deeper inside the health-care system.

Navigating that system -- and, increasingly, fighting it -- can be expensive. With coverage shrinking, people are looking for help in dealing with the details. There are doctors' appointments to book, insurance companies to pay, medications to monitor. But there are companies that'll shoulder that burden for you. For a price, of course.

Marketplace's Caitlan Carroll reports on the growing ranks of health-care handlers.


NICOLA FUSANO KING: Oh, my goodness, sleepy eyes . . .

CAITLAN CARROLL: Nicola Fusano King picks up her 2-year old son, Cayden, from a nap. He has a little cold. King's not worried. She's already seen the worst.

When Cayden was 2 weeks old, he woke up one night having trouble breathing. King couldn't reach the doctor on call so she went straight to the emergency room.

FUSANO KING: So we started rolling him down the hall and he arrested full in the hall. So I looked at him and said, "Oh, my god, I don't think he's breathing. He's gray. And so . . .

Doctors revived Cayden, who was diagnosed with a severe staph infection. He needed weeks of quarantine and expensive medications. King wasn't concerned about the cost because she and her husband had insurance. Then she found out her son wasn't covered under the policy. Within the first four days, the Kings racked up $300,000 in medical bills.

FUSANO KING: We had already decided basically in the waiting room that we would sell our house, we would move into an apartment, downgrade our cars and, obviously, I had to go back to work.

The Kings paid about $100,000 of the bills and fought with their insurance company over the rest. Desperate for help, Nicola King hired Guardian Nurses. It's a company that provides advocates who help people negotiate the health-care system.

So, for $1,500, King outsourced her fight with the insurance company to health advocate Betty Long.

FUSANO KING: I just made copies of thousands of pages of stuff that I had at that point and sent her box after box. And then she would just send me, literally, weekly updates.

Betty Long had been a nurse for 25 years before starting Guardian Nurses.

Betty Long: It became abundantly clear to me that patients were not finding it easy to navigate the health-care system, and I thought there has to be a way in order to, you know, to kind of help those folks get through it.

Health advocacy companies make up a tiny fraction of the health-care field. But experts say the market is growing as people feel squeezed between full-time work and full-time management of their family's health care. Advocates can search for specialists, book doctors appointments, and keep track of medications. They'll also manage electronic health records, and provide a second set of ears during a consultation.

Laura Weil directs the only health advocate training program in the country at Sarah Lawrence College in New York.

Laura Weil: You know, in the old days, we had a more paternalistic model of medicine that you had a family doctor who made choices for you. You trusted that person. And that person saw you through from the beginning to end of your treatment. That's certainly no longer true.

This fragmented system doesn't just affect family members, but employers too. Dealing with health-care at work eats into productivity.

Michelle MacGaffey oversees human resources for a small nonprofit. She's thinking about adding the health advocate service as an employee benefit.

Michelle MacGaffey: The ultimate goal, I think, for a benefit like this would be the overall savings for us -- both the bottom-line savings but also just from the lack of resources that we have here in the human resources area.

Companies pay around $60 to cover an employee for the year. An individual who hires a health advocate could pay $300 for a day of help at the hospital or a lot more for round-the-clock care.

The Kings, if you remember, negotiated a $1,500 fee with Guardian Nurses to take on their insurance battle. And it paid off. After months of wrangling, Betty Long had the Kings' entire bill -- about $200,000 -- written off by the hospital and the insurance company.

FUSANO KING: You know, without her, I just don't know what we would have done without her, honestly. I just don't know.

Now King's pregnant again and thinking about having Betty Long on call -- just in case.

In Los Angeles, I'm Caitlan Carroll for Marketplace

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In my view, registered nurses with clinical experience are best positioned and trained to be patient advocates. As this field grows, let the buyer beware.

There are advocates now across the country, and a National Association of Private Healthcare Advocates is now forming. Healthcare Liaison in Berkeley, CA has implemented the first credentialing program in the country for Private Healthcare Advocates. Be sure your Advocate has good medical training and experience in both in-patient and out-patient settings.

This is another excellent example of nurses acting as advocates for people when nobody else will-- not the primary care doc, who is overburdened and squeezed by the "health" insurance carriers, not the employees of the hospitals or carriers, not the employers who bought the policies for their workers. Nurse case managers are out there for people to use as advocates, as eyes and ears, as facilitators, as negotiators, and as educators. We are experienced in these fields; we are the best sources for this sort of support anyone could get in today's "healthcare" morass. Three cheers for Betty and others who have recognized this huge need and applied the nursing process to it. Great business model, great service... great nursing!
Wendie A. Howland RN MN CRRN CCM
Nurse life care planner and case manager

This problem is that it's both sides of the case.As a registered nurse, I have worked with many friends, family members, and patients to help them through their health care issue. Not all of their issues, however, are insurance related. Patients need help and who better than a nurse to help them? As an organization, Guardian Nurses offers many other clinically supportive services to patients to help them prior to incurring hefty bills from hospitalizations. Thank You!
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rosy
<a href=http://www.shepelskylaw.com>http://www.shepelskylaw.com</a>

This problem is that it's both sides of the case.As a registered nurse, I have worked with many friends, family members, and patients to help them through their health care issue. Not all of their issues, however, are insurance related. Patients need help and who better than a nurse to help them? As an organization, Guardian Nurses offers many other clinically supportive services to patients to help them prior to incurring hefty bills from hospitalizations. Thank You!

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<a= href"http://www.shepelskylaw.com"> http://www.shepelskylaw.com</a>

In this day and age, it's naive to expect a health insurance company to be your advocate. That alone is indicative of how pathetic the healthcare system in this country is.

Premiums increase, co-pays increase, and now one just may have to add an additional $1500.00 to pay someone else to beat back the onslaught from one's own health coverage provider? Can this become a bigger racket?

Good story. As a registered nurse, I have worked with many friends, family members, and patients to help them through their health care issue. Not all of their issues, however, are insurance related. Patients need help and who better than a nurse to help them? As an organization, Guardian Nurses offers many other clinically supportive services to patients to help them prior to incurring hefty bills from hospitalizations. I've used Guardian Nurses and was very pleased with their help and guidance.

This problem is that it's both sides of the case. What is the answer? Not sure. I'm among the uninsured. I had an eye emergency last year and a kind doctor charged me the Medicare rate of $40 a visit. It took three visits, one to get five splinters out of my eye and two for followups. During the one time brief time a long time ago when I had insurance I went to a chiropractor and it seemed like the visits were never going to end -- three times a week. I finally ended it myself and I was fine. And I have spoken to people who have seen lots of overbilling for office procedures and hospital visits. Like the financial markets, I believe there is corruption on both sides. What is the answer? I don't know. But I do know that health care should not be for-profit and it should be available to everyone. How many employees really know the cost of the health insurance they are being provided or the actual cost of the procedures they get or the pharmaceuticals prescribed? From people I've talked to they don't. I only know actual cost because I am uninsured and if I do have to see a doctor I ask what all the charges are. Usually offices are not happy 1) that you're uninsured and 2) that you want to know what the charges are. There's a lot of food for thought about this whole mess.

The bigger question IMHO is: How could one rake up $300K worth of charges for 4 days of care!!! Everytime people complain their healthcare is expensive, they automatically blame the Insurance company, but no body questions extraordinary amount on the bill! I'm told that it's common practice for hospitals and Dr offices to bill 300% to 500% of MediCare fee schedule!!! Is that fair?

Food for thought!

You missed the other higher education program for health advocacy - the Center for Patient Partnerships at the University of Wisconsin-Madison. We offer a Consumer Health Advocacy Certificate (12 credits) which includes hands-on training in patient advocacy - students work with patients and family members like those in your story as part of their education. For more information visit out website at www.patientpartnerships.org

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