Author: Kathleen Doheny | July 21, 2022
Seniors who experience unsatisfactory treatment in healthcare don’t have to suffer – they can become their own healthcare advocates. Why? Here are a few likely scenarios:
Your doctor won’t call (or email) you back.
You aren’t on the same page with your new doctor.
You aren’t sure about switching to a new doctor. How could you check his or her credentials or learn if he or she has been disciplined?
Sound familiar? These are a few of the healthcare questions and dilemmas that most people encounter. As frustrating as it can be, help is at hand. You can be your own healthcare advocate – and call in the pros when needed.
Healthcare Advocacy 101
Know your rights: “The most important thing is to really know what your rights and benefits are,” says Dena Feingold, a board certified patient advocate and co-director of The Alliance of Professional Health Advocates (link is here). “That requires you to read your health insurance documents and ask a ton of questions if there’s anything you don’t understand.”
Be prepared: Laying the groundwork to getting good care is important, says Emily Brown, a spokesperson for the National Patient Advocate Foundation. “First, you need to come prepared for your appointments. You should know your health history, current medication lists, and write down your symptoms and how they affect your everyday life.” Bring a list of questions—it shows the provider you are invested in your own care and the doctor-patient relationship. Discuss what you want and what you think needs to be changed about your care plan. And take someone with you.
Advocacy when Issues Arise
Finding a new doctor: “Talk to your other providers, nurses, healthcare professionals,” Brown says. “They can recommend someone who has a good reputation and who they trust.” If you’re in a healthcare group such as an HMO and are switching doctors within the group, check the webpage for the CVs of their staff doctors for information about their education and experience.
Checking out a potential: So you have some names of a potential new doctor; how to background check? Your state’s medical board is a start. The Federation of State Medical Boards maintains a list, with contact information—as well as links to file a complaint. Searching by name, you can verify license and board certification and look at public record actions, such as disciplinary actions. Sites caution that completeness of the records and disciplinary action isn’t guaranteed. You can also google a bit—try “name of doctor” and “lawsuits.” Again, not foolproof, but may turn up some facts you need to know.
Appealing a Denied Drug: If your request for a specific drug is denied as it is ‘’not on the formulary,” the list of medications covered by your health plan, you can appeal. The National Center on Law & Elder Rights posted how-to instructions from the Medicare Rights Center, an advocacy organization.
Requesting Out-of-Network Care: “If a doctor you need to see is out of network, you may have the right to appeal or request an exception for your insurance company for out-of-network care, especially if there is not a provider in the network that has the expertise or training to treat you,” Brown says. You may need to get prior approval, but in the end you may be able to get the out-of-network care without the out of network costs. Asking your doctor to get personally involved sometimes helps, Feingold says.
Keeping Your Cool: “Sometimes when health care situations go wrong, it’s hard not to feel angry,” Feingold says. However, she stresses its important to stay calm and pleasant. ‘’You may be more likely to get what you need. That said, be firm and confident.” You can get through what feels like the impossible if you know what you are entitled to and ask good questions.
Getting a Little Help: If it gets too overwhelming, you might want to seek help from a patient advocate. Ask if your medical center has one. Or seek help from organizations such as the Alliance of Professional Health Advocates (for their directory of members, visit www.advoconnection.com) or the National Patient Advocate Foundation.