Navigating Healthcare

Be an Advocate and Build an Army - Part I

The past thirty-five (35) years of negotiating the American Healthcare System seems like living many lifetimes and having many masters. The changes have been constant with periods of feast and famine and seeing many healthcare providers come and go. The client/patient is continually in a healthcare state of angst. 

There are too many aspects of our complex Healthcare System for one short article to cover. That is why this section of the website is going to be an ongoing step-by-step approach of how to be your own best advocate and how to build a trusted network for your mental and physical health.

Years ago, I started an exclusively Home-Based Therapy Practice. This was a house call practice where I delivered individual and family therapy services in the home in accordance with CMS (Centers for Medicare & Medicaid Services). Insurance did not pay for “case management” which meant that I did a considerable amount of unbillable, free services for clients and their families.

It was a no-brainer to see that the life stressors of physical illness, aging, financial constraints, needed help in the home, lack of ability or know-how to obtain needed benefits and services, etc., were causing significant, diagnosable anxiety and depression. However, insurance did not pay for mental health professionals to provide case management. 

Case Management is a process where healthcare providers diagnose, plan, obtain, implement and evaluate healthcare services for a patient. The goal of case management is to address the needs of the patient in a cost-effective manner. 

Currently, insurances have differing concepts of case management and will only provide coverage according to their limited guidelines. The concept of long-term therapy and care may not be seen as positive by insurance companies, and they often want a therapist to titrate down. 

Patients getting better can mean it is time to start discontinuing the positive therapeutic work that the therapist and client/patient have accomplished and discontinue the progress and process toward more productive goals and functioning. Achieving and maintaining Optimal Mental Health is not necessarily the goal of the insurance company.

When I went into the home, met the client/patient and family, the first focus was on the primary caregiver, their level of exhaustion and what tasks they were doing each day. That focus involved helping that caregiver to obtain needed assistance to help them be present as a wife, husband, son, daughter, brother, sister or friend. 

A family member or friend can not be a doctor, nurse, CNA (Certified Nursing Assistant), chef, housekeeper, accountant, therapist, chaplain, etc., all on their own. They need an army of helpers. 

The first order of business was to explain my role as a therapist and their rights as a client. They were provided written “Client Information” explaining the following:

1. How appointments are scheduled

2. How the costs for my services are paid

3. The binding meaning of Confidentiality and the exceptions to HIPAA Privacy Rule which are a therapist must report suspected child abuse, adult abuse, neglect or imminent harm to self or others.  

The second order of business was to review their insurance plan, income, what services they were currently receiving and what agencies and healthcare providers were involved.

The first session or meeting in the home generally lasted two plus hours. We jointly completed the following:

1. Permission to Treat

2. Information about Client 

3. Authorization for Insurance

4. Patient Fee Agreement

5. Medication History

6. Psychosocial History 

7. Releases of Information for All Involved

8. Treatment Plan

The relief on the faces of the patient and caregiver that help was available, they were not on their own and a graduated plan could be put in place was and is forever inspiring. This is what we, as mental health providers, are meant to do.

We can also teach and train our clients how to become their own best Advocate and Network Builder. We are meant to help and that means helping clients to help themselves and others.

Be an Advocate and Build an Army Part II will go into how an individual can take charge of their own healthcare and how to build a supportive healthcare network. You are ultimately the one in charge of your physical and mental well-being. You may encounter battles along the way but there is support and resources. 

Beginning Steps

1. Find a Primary Care Physician that you trust and who engages in mutual communication. 

2. Learn to be a good reporter of your signs, symptoms, reactions to any medications, achievements and goals. 

3. Keep a Health Journal. 

4. Make Lists of Questions.

5. Get to Know Any and All Medications Prescribed.

6. Talk to Your Pharmacist about each medication, side-effects, reactions with foods, other medications and supplements.

7. Thoroughly discuss the costs and need of tests.

8. Keep a check on your emotions and anger. Many physicians don’t do emotional work.

9. Don’t tolerate rude, patronizing and disregarding communication.

10. Get a second opinion when dissatisfied or uncomfortable.

11. Build your Healthcare Network. (It is a good rule to find people in your network who have some type of healthcare experience, training or knowledge.)

12. Include all your Healthcare Providers as part of your Healthcare Network. Keep them informed at all times.

13. Continually educate yourself through credible, reliable and trusted sources.

14. Learn to start trusting you.

Send your stories and questions.  See the section below.