Sponsored: KTS Advocacy helps individuals navigate the complicated healthcare system

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This article is written by Karen Silber, MSW, LSW, BCPA Board Certified Patient Advocate Social Worker, Owner of KTS Advocacy.

The health care system is so complex that more than half of consumers are unable to navigate it, triggering avoidable customer service calls and more costly care.  KTS Advocacy is an independent professional healthcare advocate owned and operated by Karen Silber, Master’s prepared social worker and Board Certified Patient Advocate (BCPA). Karen is filling a gap in the Greater Cincinnati/Northern Kentucky region by supporting people locally and others virtually across the U.S.

Karen is a native to Northern Kentucky, beginning her career at St. Luke East Hospital in Fort Thomas (now St. Elizabeth) as an oncology social worker. She continued her passion as a home care liaison at Mercy Hospital, clinical social worker at Drake Center’s Long Term Acute Care (LTAC) supporting those with traumatic and complex needs. She then gained significant knowledge at UMR, a subsidiary of UHC and third party administrator (TPA) where she specialized in health and wellness, worksite wellness and care management. 

She has advocated for her parents, brother, and herself when dealing with her own chronic condition, Chiari Malformation. James Noll, attorney in Newport, states “She cares about people and their overall well being. The mind-body-spirit connection is not just another motto to put on her clipboard. Karen wears it on her sleeve and in her heart.”

So what is a Healthcare Patient Advocate?

A healthcare advocate is someone who provides direct and personalized services to a patient and/or their family as they navigate the healthcare system. They can act as a communication bridge between healthcare providers and patients/families. Advocate services are private pay and not at this time covered by insurance.  Some employers have begun providing advocacy support to their employees as a part of their benefit package.  An employee’s Health Savings Account may also be used for patient advocacy services.

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Karen will be your C.A.L.M. – Case manager, Advocate, Liaison, & Medical navigator

Some examples of what Healthcare advocates may do:

• Schedule and attend appointments with patients
• Translate medical jargon
• Communicate medical information to family members
• Research treatment options, providers & facilities
• Medical records review
• Assist with transition home from the hospital
• Arrange community resources
• End of life planning/advanced directives
• Assist with insurance denials and coverage issues
• Review and negotiate medical bills
• Access financial or legal resources
• Assume power of attorney role
• Support/guidance for mental health & substance abuse issues
• Wellness and preventive health coaching

Who can benefit from a Healthcare Patient Advocate?

Older adults: Older adults may be intimidated when trying to understand bills, talking to agencies regarding applications, or deciding next steps when overwhelmed with choices. It can be difficult to speak when they’re unsure of what to say. They may live alone and/or have adult children who live out of state and need the guidance and support. Experienced advocates generally have legal and medical knowledge that their friends or families lack.

Hospitalized patients: Those in the hospital may not have the energy or may be sedated to where they can’t speak for themselves.  An independent advocate can be by the patient’s side and ensure the hospital staff is following their wishes. They can act as a liaison between the patient and provider then communicate information back to family if needed. At the time of discharge, they can review discharge orders including medications to ensure they are clear and concise in order to decrease the chance of a readmission.

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Employers: More than 1 in 6 working Americans report assisting with the care of an elderly family member or friend and that it significantly affected their work life.  Caregiving has shown to reduce employee work productivity and increase the likelihood of employees leaving the workplace. Adding a healthcare advocate to an employee benefit package allows employees to be supported through their healthcare journey. Outsourcing to a patient advocate saves staff time to spend on other HR matters. Absenteeism is reduced as employees spend less time trying to resolve their healthcare issues.  They feel supported by their employers, showing care & concern, and a huge benefit to their employment.  The advocate saves them time, headaches, and money.

Advocate examples:

  • Elderly woman was receiving hospice in a nursing home.  Her daughter felt her condition was worsening and requested 24 hr care in a private room.  The daughter hired a Healthcare Advocate who worked with hospice on arranging continuous care along with coordinating a move nursing to a private room.  After 12 hours in a peaceful environment, the woman passed away.  The daughter was able to be family instead of a ‘caregiver’ with the advocate’s support.
  • Adult children of an elderly man hired a Healthcare Advocate to help with their dad’s upcoming surgery by attending appointments with him, coordinating his transportation to and from his home for appointments, and then sitting bedside with him at the hospital after surgery. The adult children all lived out of state, so the advocate was able to provide a huge support to their father and themselves.
  • An employee needs a procedure and the prior authorization has been denied by his insurance.  The employee had access to an advocate through his employer’s benefit package.  The advocate reviewed the denial letter and contacted the Utilization Review department at the insurance company.  After working with the insurance company and understanding the medical necessity guideline requirements, the provider was contacted who resubmitted the request, which then allowed approval for the procedure.  Utilizing the advocate allowed the employee to be less stressed, more productive and a huge time saver for not only the employee but the HR staff.
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Skills Karen brings to the advocate role

Karen can break down the complexities of the healthcare system into terms that the lay person can understand and communicate clearly to healthcare providers as well as insurance companies. Karen has empathy and compassion for those dealing with overwhelming situations and provides emotional support.  With all her years in discharge planning, she understands the need for expert coordination, organization and attention to detail.  She also excels at problem solving and is an analytical thinker when tasked with disputing claims and prior authorization denials. 

If you are an older adult, an adult child of an ailing parent, an employer wanting to support their employees, or overwhelmed and agonizing over a healthcare issue, contact Karen Silber at KTS Advocacy, 859-363-5981 or by visiting ktsadvocacy.com.

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