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PATIENT ADVOCATES

The concept of "Patient Advocates" has different expectations under varying circumstances for different people. We are using it here to describe our view of the relationship and potential responsibility that a Neurosurgeon may have regarding "Patient Advocacy" for his/her patients.

Hippocrates left a legacy of scientific curiosity and personal integrity, part of which is reflected in the Hippocratic Oath. In his magnum opus "Epidemics, Book I, Section XI", he wrote: "As to diseases, make a habit of two things — to help, or at least to do no harm."

Subsequently, the Roman physician Galen, translated this phrase into Latin as "Primum non nocere", the translation of which is "First, Do No Harm". This statement defines a way of thinking which places the welfare of the patient above other concerns. This principle applies in the modern environment as well as it did centuries ago when the concept was initiated into practice.

Today's practice of medicine is far more complicated than it was in previous decades. While the technologies, medications and procedures have become considerably more sophisticated, the complexities of the entire health care system have evolved into one that many patients view as unfathomable. Although we are at our most vulnerable when illness besets us, the need to comprehend these complexities is essential.

Dealing with a major Neurological problem that warrants Neurosurgical intervention is stressful. Having to comprehend and manage an insurance company's rules and regulations can be daunting. This may include: pre-certifications for procedures and hospitalization, identifying financial responsibility for co-payments or out-of-pocket expenses, understanding a hospital's demands for financial disclosure and guarantees of responsibility as well as having to decipher complex hospital forms. An example of one of the more complex and important forms is the "Advanced Directives". At a time when one is concerned for one's life and Neurological integrity, these additional issues can become overwhelming.

Neurosurgical Office Staff as YOUR ADVOCATE

This is where the Neurosurgeon's office staff and the Neurosurgeon often become YOUR ADVOCATE. The requirements of insurance companies vary from one to the other. Most Neurosurgical offices have staff members who are familiar with and manage these matters for you. Often times, the staff will automatically "pre-certify" with your health insurance company, your neuroimaging investigations as well as your operation. They are familiar with the terminology and unique "coding" requirements of insurance companies as well as hospitals.

How Your Neurosurgeon can Help

Your Neurosurgeon will, on occasion, be required to write to the insurance company, government agency or your attorney on your behalf. While you are in the hospital, your Neurosurgeon may need to support your need for a higher level of nursing care, special treatments, access to specialized equipment and a longer stay than is ordinarily underwritten by the insurance company (or Medicare.) These duties all fall under the concept of a Patient Advocate.

Limitations

Unfortunately (and very importantly) there are limitations that the Neurosurgeon and the office staff are working under when it comes to your insurance company. Since you, another family member or an employer made a choice regarding the actual company contracted with, the extent of coverage purchased on your behalf may have significant monetary, as well as procedural limitations. This may mean that some Neuroimaging and/or Operations, even though they are clearly medically indicated, may not be covered. The Neurosurgeon's office may be able to assist you in identifying these parameters; however, they will have no capability to change those limitations on your behalf. This contract is between you and that company.

Hospital Resources

Some hospitals employ a Patient Advocate to help patients with issues that arise during their hospitalization. Other hospitals employ Social Service professionals to assist patients with their ancillary needs such as home care nursing, nursing home placement, rehabilitation, travel arrangements among other issues. These professionals are available to you and look forward to assisting you and your family.

Online Information

There are other circumstances where additional Patient Advocacy concepts may be of interest and value to you. We invite you to explore some of the following websites and information for a broader understanding of these issues.

Patient Advocate Foundation Patient Advocate Foundation is a national non-profit organization that seeks to safeguard patients through effective mediation assuring access to care, maintenance of employment and preservation of their financial stability.

The National Patient Safety Foundation has an excellent reference PDF file entitled "The Role of the Patient Advocate: A Consumer Fact Sheet."

The Patient Navigator, Outreach, and Chronic Disease Prevention Act of 2005 is a Federal Law that was designed to provide patients with an advocate at their side to help them navigate through today's complicated health care system and will improve access to prevention screening.

The bill has been endorsed by a broad coalition of health care advocacy groups, including the American Cancer Society, the National Association of Community Health Centers, the American Diabetes Association, the National Patient Advocate Foundation, the National Health Council, and the American Medical Association.

Information concerning this Bill is available on the Internet as well.



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This page last edited on 2/19

All content ©2016 by Neurosurgical Consultants, P.A.
Author, Martin L. Lazar, MD, FACS
All Rights Reserved. See Usage Notices.