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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.

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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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