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Personal Finance
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Aspirin for your healthcare headaches
Professional problem solvers can fix your bureaucratic conundrums and help with wrenching decisions.
November 1, 2004: 9:15 AM EST
By Ellen McGirt, MONEY Magazine

NEW YORK (MONEY Magazine) - Your hospital bill arrives in a tangle of errors. Grandpa needs a good nursing home. And all you want is some aspirin and someone to help you figure out the right thing to do.

As health insurance rules get nuttier and nuttier, new types of problem solvers have emerged to help you cut through red tape, decode medical jargon and deal with the emotional realities of illness and aging.

Below is a look at three of these new problem solvers: medical billing advocates, personal patient advocates and geriatric care managers.

A quick reminder, though: Since many of these fields are relatively young, doing solid background checks will be key to finding good help. Ask for credentials and references from everyone you interview. Check any licenses they hold with the agencies or groups that issued them. Then, once vetted, make sure the expert you choose has the specific skills -- and personality -- your problem requires.

Medical billing advocates

When unintelligible hospital bills and rejected insurance claims threaten to chomp through your checkbook, call in your own attack dog.

"I've seen it all," says billing advocate Cindy Holtzman of Marietta, Ga. "Most medical bills are either wrong or padded beyond belief. An 'oral administration fee'? That's a pill in a paper cup."

Advocates know the arcane lingo of medical billers, a hazy hybrid of hospital codes and insurance argot. Some are even accountants or registered nurses.

Holtzman worked daily for a month to sort out a labyrinth of claim denials and billing errors on $12,000 in hospital charges for client Beverly Browning. The result? A refund of $1,000 for Browning. "I couldn't have gotten it without Cindy," she says.

Medical billing advocates also can unearth money or discounts to which you may be entitled. "They found a VA benefit I didn't know I was eligible for," says Jack Toney of McDonough, Ga. "I was facing $16,000 in bills that I couldn't pay."

How much: Hourly rates range from $30 to $150. Complex projects may involve a commission on the savings the advocate produces. His or her cut could be as much as 10 percent of those savings.

How to find them: Check out Claims.org or Billadvocates.com.

How to check them out: Zero in on specific credentials and experiences. Are they trained medical coders (also known as claims specialists)? Have they worked in a health-care setting? Extra points if they've tackled problems similar to yours.

Personal patient advocates

The newest trend in navigating the health maze is simply to do an end run.

Personal patient advocates offer premium services -- like finding cutting-edge specialists and booking your appointments, joining you on doctors' visits, keeping your medical files up to date and coordinating follow-ups-often at premium prices.

If you're managing a chronic condition, it's like a personal shopper for health care.

"It's expensive, but worth it," says Richard Rossi of Washington, D.C., an entrepreneur who joined Pinnacle Care International, a patient advocacy firm, after watching a chronically ill friend's struggles. "I know they're finding the best doctors and procedures I need, whenever I need them."

Advocacy firms such as Care Counsel, Health Advocate and Patient Care often market their services through employee-benefits offerings at large corporations.

How much: Patient Care charges $180 annually for an individual and $300 for a family. At the ultrahigh end, Pinnacle charges a minimum of $5,000 a year on top of a $10,000 initiation fee.

How to find them: Check Patientcare4u.com or Pcistaff.com.

How to check them out: Look for someone who is familiar with your illness or care needs, and is current on the providers and treatments you may require. Be sure to interview more than one advocate.

Geriatric care managers

From conducting assessments before a loved one is admitted to an elder-care facility to explaining benefit complexities, geriatric care managers can provide advice and comfort for seniors and their families when it's needed most.

"We often get calls when there's a crisis," says Linda Aufderhaar, vice president of the National Association of Professional Geriatric Care Managers (NAPGCM). "There's been an accident, a cognitive change, or families are simply having difficulty managing someone's chronic-care needs."

Managers typically are trained as social workers, registered nurses, therapists or benefits experts, and they are familiar with the caregivers, agencies and health networks in their zip codes.

Some families use care managers just a few hours a month; others rely on them full time. Lillian Buck of Wethersfield, Conn. hired a firm to supervise care for her widowed mother, a stroke patient who lives 3,000 miles away. "They meet her at her doctor's, coordinate her medication and paperwork and do spot-checks on her home health aide," Buck says. "They call me once a week to keep me posted -- whatever we need."

NAPGCM now has more than 1,700 members and says its ranks are currently growing 30 percent a year.

How much: Hourly rates range from $75 to $150. Larger practices can offer direct nursing services in addition to your typical bureaucracy-busting.

How to find them: Check Caremanager.org.

How to check them out: Call several care managers, make sure their licenses are current, and get a sense of how well they know the facilities, resources and providers in your area. Do a gut check: Do you like this person? You're hiring a surrogate family member, so chemistry counts.  Top of page




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Most stock quote data provided by BATS. Market indices are shown in real time, except for the DJIA, which is delayed by two minutes. All times are ET. Disclaimer. Morningstar: © 2018 Morningstar, Inc. All Rights Reserved. Factset: FactSet Research Systems Inc. 2018. All rights reserved. Chicago Mercantile Association: Certain market data is the property of Chicago Mercantile Exchange Inc. and its licensors. All rights reserved. Dow Jones: The Dow Jones branded indices are proprietary to and are calculated, distributed and marketed by DJI Opco, a subsidiary of S&P Dow Jones Indices LLC and have been licensed for use to S&P Opco, LLC and CNN. Standard & Poor's and S&P are registered trademarks of Standard & Poor's Financial Services LLC and Dow Jones is a registered trademark of Dow Jones Trademark Holdings LLC. All content of the Dow Jones branded indices © S&P Dow Jones Indices LLC 2018 and/or its affiliates.