Advocates for patients cut red tape

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Advocates for patients cut red tape by Jodie Snyder

The Arizona Republic Mar. 4, 2007 12:00 AM

Faced with a brain buster of a medical bill, Carole Falconer got help

from an unlikely place: someone on her boss' payroll. Falconer's

employer, Avnet Inc., is one of a growing number of employers and

individuals who would like to cut through the red tape strangling the

American health care system.

One possible solution? Patient-advocate-for-hire companies.

As patients become more responsible for their own health care and for

picking up a greater share of the tab, there are a growing number of

companies offering to help them cut through the red tape and sort

through medical information.

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Avnet hired Health Advocate, a national company that specializes in

patient advocacy, in November 2004 just as the Phoenix electronics

distributor rolled out major benefits changes, including offering more

consumer-directed health plans. Since then, Health Advocate has helped

with 1,500 calls from Avnet employees. Most calls have involved

helping people file claims or understand medical options.

" The reaction has been extremely positive, " said Fink, vice

president of compensation and benefits for Avnet, which has 6,000

employees in the United States and is the largest of the four Fortune

500 companies based in Arizona.

For Falconer, who has been with the company for 20 years, the patient

advocate was a godsend.

Last year, she got a stack of medical bills riddled with incorrect

billing and diagnosis codes. She faxed the materials to Health

Advocate, and within two days she had gotten a call saying everything

was taken care of.

" Oh my God, I couldn't believe it, " said Falconer, who works in

Avnet's Bloomington, Minn., office.

Because Falconer's husband has a number of health problems, she is

used to working through the healthcare maze. It's nice to have help

getting through it, she said.

" I hate calling insurers at work, but that's the only time they are

open. And you have to go through 48 prompts to get a real person. "

Fink believes Health Advocate has saved employees thousands of dollars

by finding cases of overcharging and double billing.

For Avnet, the payoff is higher employee productivity. Fink estimates

that for every hour Health Advocate is working an employee's case, it

saves the employee three hours of time.

Avnet is one of a dozen Arizona companies that use Health Advocate,

which has more than 7.5 million members under contract with 2,200

employers, unions and insurers. Employers generally pay from $1.50 to

$5 per employee per year for the patient-advocacy services.

Started in 2002 by former insurance executives, Health Advocate offers

services ranging from investigating medical bills to helping

coordinate care.

People who can't get in to see a specialist frequently call the Health

Advocate hotline, said Marty Rosen, the company's executive vice

president.

A patient who has just been told he or she has cancer wants to see an

oncologist immediately. From the oncologist's perspective, getting a

call from a cancer patient is routine. To see an oncologist more

quickly, it's important to state logically and clearly why you must be

seen immediately, Rosen said.

Health Advocate tries to build a factual case to get appointments faster.

" There is a lot of triage done in emergency departments but not so

much in doctor's offices, " Rosen said. " You have to explain why you

need to be seen before other people. "

Local options

For patients who don't have access to companies like Health Advocate,

there are alternatives.

For $275 a year, the Patient's Advocate in Sun City will go though

stacks of medical bills, no matter how high, to figure how much

patients owe or if there is actually money coming to them. In one

case, the Patient's Advocate got a woman an $80,000 refund, said

Sharyon Rampertab, the company's owner.

The company focuses on Medicare issues but will handle insurance

problems for people with workers' compensation cases and catastrophic

accidents.

The business also will review long-term care and medical insurance

policies.

Online clearinghouse

Rampertab's company deals with medical bills, but there's a new group

forming that may help people navigate data on the Web.

Debra Nixon, a longtime Arizona health care executive, is starting

efforts to be a clearinghouse for people sorting health care

information they find online. The Health Guide America, a non-profit

group, wants to be a companion piece to advice that people find on

online through sites such as WebMD. The guide, which would be online

as well as have a telephone hotline, would answer questions on how to

find good medical information on the Web or how to find insurance or a

doctor.

Nixon is talking with federal and state governments about starting the

program.

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