Getting To Yes: The Essence of Patient Advocacy

A new client said to me ” I just want a yes instead of no all the time.”  She called me because a patient advocate’s  job was to find yes in a sea of no.  The no may can come from any segment of the healthcare system. It could be an insurance company  refusal to approve a procedure or pay a bill;  a scheduler who won’t give an earlier appointment; a medical professional who won’t return calls or provide information; or a hospital not responding to family concerns.  The list of negatives and barriers is long in our current healthcare system.

So how do I get a no to change to yes?   I am patient, persistent and  never lose my temper.   Once I hear a refusal, I put my game plan into action. One of the most important aspects of the game plan is to make sure I speak with the person who is able to authorize the change from no to yes. For instance, with insurance companies or billing offices, I make sure I speak with a supervisor . It is not an easy task to get the supervisor on the phone as they are always “busy”.  This is when patience pays (and multiple phone messages).

I genuinely like speaking with the varied customer service departments, medical and hospital offices.  I have learned people are doing their jobs, get enough flack throughout the day and I do not need to add to it.  I am friendly and gracious so the office notes reflects how helpful the advocate was.  Of course, I have had a few unpleasant experiences. In those cases I am not put off.  I shift gears, remain patient but don’t back down.

I also have studied the system and protocols of  many institutions and insurance companies.  I make sure I have the right HIPAA  and patient representative forms submitted. By understanding systems, I have been able to formulate the correct approach to get the  quickest response.  This is important because every system has a culture that dictates how they respond.

In saying no, the hope is the patient will accept the information and go away.  To an advocate, a no is like sweet nectar.   The adrenaline kicks in, the cobwebs clear, time slows and the work begins.  My client was right an advocates job is to GET TO YES!