Insurance wants to give me an advocate

[Turtlebay]

I just received a letter from my medical insurance. They want to give me an advocate (nurse) to help me "deal" with doctors, to help me decide what meds to take and to help me to decide what test I should have. Hmmm maybe I'm just being suspicious but who's best interest does my insurance have in mind. Mine or theirs? Any thoughts? Does anyone have an insurance advocate?

[BigA]

Is it an outside company with nurses you can call 24/7, or have they assigned you a nurse to help coordinate. I have this through my insurance and it's great.

You're right to be suspicous, but it may be a good thing. Give it a try. See if you like her/him.

[0485c10]

IMO. i think....
That's a part of the new health insurance act.
the "Patient Protection and Affordable Care Act"

Now insurance companies have to prove that they are providing "essential health coverage". And one of the items defined as essential health coverages on page 103, Section 1301 Qualified health plan defined

(1) IN GENERAL.—Subject to paragraph (2),
the Secretary shall define the essential health benefits,
except that such benefits shall include at least
the following general categories and the items and
services covered within the categories:
(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder
services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and rehabilitative services
and devices.
(H) Laboratory services.
(I) Preventive and wellness services and
chronic disease management.
(J) Pediatric services, including oral and
vision care.



what you are experiencing with your insurance company is (I) being implemented with you.


the first people who experienced this from the posts that i read were diabetics with MS. i think there is greater payback when diabetes is managed correctly, so they were the first to get patient advocates.


i'm on medicare so i don't deal with private insurance so i don't have experience with theses advocates, but that is why i believe it is happening. ask the advocate why this program was started and how many insured people are in it.


your insurance company is trying to get tax breaks and be able to continue to sell health insurance on the new health insurance market.

[kelm10]

yes

I have had this in the past with my depression.

It is good to be cautious when it is from your insurance company. But, as a previous poster said is it from an outside company? If it is then the suspicion can go down.

I have also seen this for asthma too.

In my predjudice opinion, usually nurses are out to help the patient more then they are anybody else, given that I am a nurse.

[Shallwearpurple]

advocate

Our insurance provided this years ago for two of my pregnancies, 19 and 16 years ago. I did not like it. Even if it is an outside company providing the nurse, they are hired by the insurance company and so they work for the insurance company. I felt it was invasive. Even when I said no, they kept calling. They asked what the doctor said at my appointment and would give advice contrary to the doctor at times.

I know several nurses personally. If I want a different take or advice, I'll call them. They will give me advice with no strings attached. They won't be getting paid by my insurance and have no contact with drug companies.

[heliotrope]

They are an outside company, but - unsurprisingly - I get a phone call every time my medication changes. I get stuck feeling like I have to defend my doctor's choices. Not worth the time. I can do the research myself.

[rdmc]

I've had a "nurse advocate" for many years. In fact, I think ever since I was diagnosed my insurance company has had a nurse check in (via phone) with me every 3-6 months. I also have a pharmacist who calls me every few months (he's from the pharmacy that handles my Beta Rx.)

I have never felt any pressure from them. The sessions are chatty and I feel like I'm more the educator, than the educatee (wonder if that's even a word, LOL.)

The pharmacist and I have good conversations. He didn't know much about the Baclofen pump, so I had to "educate" him on how it worked and how it affected my other med changes.

I've never been denied a claim, treatment, or Rx, so I don't think it's influenced the insurance decisions for me. They have no idea what a particular person's situation is. They don't know if we're homebound or not, don't know if our doctor's coordinate treatment, so they are trying to head off any problems that a person with a chronic illness might encounter.

[Justsayyes]

My Anthem offers setting me up with an advocate. I had one with The Guardian, she called me routinely and would ask about any questions I had regarding medications, and encouraged routine visits and tests. In my case she was pushing for me to get cholesteral checked based on my age.

I opted out of this service, but some people may find it helpful.

Last week Anthem started calling for my husband saying there was an "important message". After calling the number they left, going thru all the required info input, date of birth, ID no., a computer voice advised to consider getting a routine colonoscopy.

OK......I spent all that time inputing info to get that message. Thanks.

[kellygrn]

A Huge Help

I have had to demand one before. Insurance company would pay for a hospital stay for bed sores but would not pay for cushion to prevent sores. That policy has now changed.

Currently she has helped me get wheelchair with all need equipment added, bed air flow cushion to prevent bed sores. She has been a wonderful aide in my corner.

KK

[Waydwnsouth1]

My insurance offered me the same service and I politely declined. I figured I already have more than enough medical personnel involved in my life I did not want another by choice. Now, what I did accept was the Avonex support call. They call me once a month to make sure everything is going fine, such as injections, and side effects and if I have any questions. They also offered one of their nurses as an advocate. I of course declined but they did say the nurses would always be available should I need them. Great customer service!!

[gomer]

I THINK its a mixed bag.

It might be worth at least a TRY, then you decide.

I had one once, due to diabetes, there were times she was helpful, then there were times I was not so comfortable with her attitude, seem to be for the ins co more, so I stoped.

As long as you have the option to opt out later, after trying the advocate thing, then I see no reason not to try it.

Gomer

[kbloom2]

Major RED FLAGS for me.. I do not believe in this program. I don't think an Insurance company is a DR. to advocate for a patient on med's and well being. The DR is more qualified than the adovacte (my opinion). I would ask the insurance company why are you providing this? What is to gain in providing me an adovacte?
OH my BLOOD IS BOILING. sorry. This really makes me angry

[spring]

I agree, KBLOOM2. I refused several requests and told my insurance company to "cease and desist" mailing me inane letters about having an "advocate". This is just the company's way of putting a gatekeeper up so we don't use our neurologists too frequently. Also, I resent that they know nothing about MS meds and usually assume we should all be on them ( I've tried two of them with awful results including new symptoms I never had before the meds). This is a patronizing system set up to save the insurance company money by telling the patient how to manage their own MS.

Just had to get that off my chest. ( This is just MHO; I don't wish to offend anyone who has benefitted from this program; I'm just the cynical, suspicious type !)

[Bob698]

I'd step lightly around this one.
The first question I would ask is "If I decline an "advocate" does that make me liable to having my coverage dropped or my rates increase?"
Likewise, what happens if you accept an "advocate" and they tell you that you can cure MS by installing aluminium foil on all your windows? What happens if you ignore them, do your rates go up or does your coverage get dropped?
Personally, I tend to listen to the folks who paid the most for their education.
You might want to bring this up with a local representative (a congressman or someone who serves on an insurance oversight committe) and definatly with your Neuro.

[Justsayyes]

When my first advocate realized that I was doing all the things I should, regular doc visits, routine tests for my age, and that I was more informed than she on MS, she pretty much admitted she had no more to offer me. We agreed to stop the calls.

I did find the whole business to be a bit intrusive. I can see where some might benefit, but all this invasion into my privacy bothers me.