A diagnosis of a chronic, debilitating or life threatening illness is bad enough. Often, it's just the first layer of stress. Other stressors come rapidly and when you're least prepared to deal with them.
You need a strategy to get the health care you need, keep your job and deal with the mountain of financial paperwork that comes with a serious illness. What you need is an advocate - someone who helps you with the demands from every direction that zap your energy and distract from your primary job: getting better.
Help is available.
The Patient Advocate Foundation, founded in 1996, is a national non-profit organization. With case managers, doctors and health-care attorneys, it serves as an active liaison between patients and insurers, employer and/or creditors to resolve insurance, job retention and debt crisis matters that stem from a diagnosis.
A wide variety of the foundation's services are free.
Katherine Howerter, CLSW, American Cancer Society's local patient navigator at SIU Physician Medical Group, has been referring patients to PAF for about three years. Financial help is one of her top reasons for referrals.
"The big reason I refer patients is for co-pay assistance," Howerter said. "Recently I had a patient with insurance, but the specialty medication he needs once a month had a $3,500 co-pay. It's not unusual for a specialty drug to have a $400-$500 co-pay."
PAF can broker resources to supplement insurance limits and assure access to care for the uninsured, negotiating access to pharmaceutical agents and medical necessities including chemotherapy, devices and surgical procedures. It can negotiate pre-authorization approvals and provide help to expedite an insurance appeals process.
The organization helps expedite applications for SSDI, enrollment in Medicare/Medicaid, SCHIPS and other social programs. It's there to help with myriad financial strains a serious illness can trigger.
Each PAF patient is assigned an individual case manager, who remains the point of contact throughout the process. Each patient receives a customized Patient Pak in the mail with information about their situation. Many of of the organization's 400-plus publications have been translated into Spanish.
The foundation's direct patient services increase the speed at which patients receive quality health care after diagnosis, screening for enrollment in clinical trials for patients who meet the medical eligibility requirements and referrals when appropriate. It mediates and negotiates with the full network of health-care providers including physicians, hospitals, clinics, social services providers, pharmaceutical assistance programs, and federal, state and local agencies for specific goods and services needed by the patient.
PAF is designed to increase patient survivability through sustained access to health-care services throughout the disease progression and treatment regimens.
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Reaching out to underserved groups
PAF offers 19 programs and provides the same assistance to all callers who fit the mission. But the foundation adds an outreach component for some groups.
For the senior population, there's an emphasis around all Medicare- related issues including screening and enrollment into Part D plans, low-income subsidy, Medicare advantage plans, state prescription assistance programs and appeals.
The National Hispanic/Latino Outreach Program and National African American Outreach Program are designed to reduce health-care disparities and assist patients in obtaining a better quality of life.
The goal is to disseminate information to those who are generally unable to receive reliable health care. These programs target high-risk health care often associated with these ethnic groups.
