(or why investing in the jungle of insurance competence is worthwhile for your practice)

This post was contributed by
Cindi Gatton, Pathfinder Patient Advocacy Group

Occasionally when I’m asked the inevitable “What do you do?” at a party, I answer that I am a personal fire department for health care issues.

Most calls to the fire department don’t come when people first smell smoke, but rather when someone sees flames. The reality I experience in my own practice is that many prospective clients aren’t motivated to pay for help until they see the flames. They either can’t smell the smoke, hope the smoldering will just go away, or feel their personal fire extinguisher will be enough to take care of it. Until it isn’t.

When a prospective mentee contacts me, I want to know the scope of practice they want to offer. Most of us understand the value of offering services in the “care arena” – supporting second opinion navigation, condition research, medical decision making, building a medical team or facilitating communication with one.

But when I ask about insurance services, a typical response is “I hate dealing with insurance! I’m going to find someone else to do that.”

That decision could have a significant influence on one’s ability to be successful as a private advocate.

A “cost of care” issue (selecting insurance plans, navigating insurance denials, dealing with out of network and/or surprise medical bills, optimizing long term care insurance) is often the fire that drives a search for help. Learning how to navigate the world of health insurance and health care finance may not be as sexy as supporting a patient’s medical decision-making process, but where there is a healthcare insurance issue, a care issue doesn’t lurk far behind.

By successfully helping a client save real money, and/or more effectively navigate their insurance benefits, a level of trust is established. That opens the door to a deeper conversation about when they first started to smell smoke. We can then assess their personal understanding about how payment for health care works, what’s important to them in their care, and how they made the decisions that led to their fire. Somehow the concreteness of an insurance issue earns us the trust to be more intimately involved in how a patient is manages care issues.

In 2013 the Kaiser Family Foundation published a study demonstrating that only 14% of Americans understood the four primary terms of health care insurance: co-pay, co-insurance, deductible, and out of pocket maximum.

You may be among that 14%. So how can you go deeper?

1. Find classes. AHIP (America’s Health Insurance Plans) offers classes at all levels that help prepare insurance representatives for their careers. The Life Office Management Association (LOMA.org) also offers online classes that can deepen life and health insurance understanding. Many universities offer classes in healthcare finance as well.
2. Cultivate allies in the insurance world. Most of us know someone who has worked for an insurance company. Buy them lunch. Pick their brain. Then call them for “how does this really work?” advice when you need to.
3. An insurance contract is basically a legal contract. Learning a bit about contract law can be extremely helpful when navigating an insurance appeal.
4. Listen to APHA podcasts. There are many members who have worked in the healthcare finance arena and shared their expertise.
5. Read publications about the effects of health care finance on care. Some I read regularly are Kaiser Health News, The Commonwealth Fund, and The Center for Medicare Advocacy.
6. Hire a mentor to work a case (or cases) with you. Working a case with a mentor can improve your confidence, and expand your learning in an experiential way.
7. Lastly, and most importantly, understand that it takes time to develop insurance competency as an advocate.

Yes, you can outsource this work. But you may be giving away cases that become long term, repeat clients, who spread the word throughout the forest of your powers as a fire fighter.

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