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How can you advocate for underinsured patients?

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As a case manager, you may encounter many patients who are underinsured, meaning they have inadequate or unaffordable health coverage. Underinsured patients face many challenges, such as high out-of-pocket costs, limited access to care, and poor health outcomes. How can you advocate for underinsured patients and help them navigate the complex health system? Here are some tips to consider.

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1 Assess their needs

The first step to advocating for underinsured patients is to assess their needs and goals. You can use tools such as a biopsychosocial assessment, a care plan, or a patient activation measure to identify their strengths, barriers, preferences, and priorities. You can also ask them about their insurance status, benefits, and eligibility for other programs or resources. By understanding their needs, you can tailor your interventions and referrals accordingly.

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Raphael Thimon(M.I.A)

Mandataire d'intermédiaire d'assurance
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Oui j'appelle ?a l'enquête preliminaire, indispensable avant de lancer toute étude en matière d Assurance c'est aussi ce qui correspond au recueil de besoins.

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2 Educate them on their options

The next step to advocating for underinsured patients is to educate them on their options and rights. You can inform them about the different types of insurance plans, such as HMOs, PPOs, EPOs, and HDHPs, and how they affect their coverage, costs, and choices. You can also explain the terms and concepts related to insurance, such as deductibles, copays, coinsurance, network, and prior authorization. You can also help them understand their rights and responsibilities as consumers, such as how to appeal a denied claim, how to request a hardship exemption, or how to file a complaint.

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Raphael Thimon(M.I.A)

Mandataire d'intermédiaire d'assurance
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Tout à fait d'accord. Le jargon de l'assurance à besoin d'être explicité, voir vulgarisé au maximum. Ce n'est pas toujours facile. La recherche d'un tarif le plus bas pousse certains vers la sous-assurance.

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Thomas "TJ" Johnson

CEO THP Benefits LLC
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I believe education is key, especially for insurance. Understanding the language of insurance can be daunting even for those involved in the industry. Insurance is one of the few products that at the time of service one has no idea how much the service will cost. Proper education can help one understand out of pocket costs. i.e. what counts toward the deductible, when does coinsurance start, when does the deductible reset. Only after understanding one's policy can one self advocate.

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3 Connect them to resources

The third step to advocating for underinsured patients is to connect them to resources that can help them access and afford care. You can help them enroll in public programs, such as Medicaid, Medicare, CHIP, or VA benefits, if they qualify. You can also help them find low-cost or free services, such as community health centers, sliding fee clinics, or prescription assistance programs. You can also help them apply for financial assistance, such as charity care, discounts, or grants, from hospitals or other providers.

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4 Coordinate their care

The fourth step to advocating for underinsured patients is to coordinate their care and ensure continuity and quality. You can communicate and collaborate with their primary care provider, specialists, pharmacists, and other members of the care team. You can also monitor and follow up on their appointments, tests, treatments, and medications. You can also help them manage their chronic conditions, prevent complications, and adhere to their care plan.

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5 Empower them to self-advocate

The fifth step to advocating for underinsured patients is to empower them to self-advocate and become more engaged in their health. You can teach them skills and strategies to communicate effectively with their providers, ask questions, express concerns, and negotiate fees. You can also encourage them to use tools and technologies, such as patient portals, mobile apps, or telehealth, to access and manage their health information. You can also support them to make informed decisions, set goals, and take action to improve their health.

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Raphael Thimon(M.I.A)

Mandataire d'intermédiaire d'assurance
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Oui garder un canal ouvert pour repondre à la moindre interrogation de nos clients. Etre acteur de leur santé, de leur contrat, insister pour être connecté à leur portail, application qui offre beaucoup d'informations (médecins, professionnels agréés, offres appareils etc...)

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6 Advocate for system change

The sixth and final step to advocating for underinsured patients is to advocate for system change and address the root causes of health inequity. You can participate in policy and advocacy efforts, such as joining professional associations, signing petitions, or contacting legislators, to promote universal health coverage, health reform, and social justice. You can also educate and raise awareness among your colleagues, peers, and community about the challenges and needs of underinsured patients. You can also contribute to research and evidence-based practice to improve the quality and outcomes of care for underinsured patients.

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7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?

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How can you advocate for underinsured patients?

1

2

3

4

5

6

7

1 Assess their needs

2 Educate them on their options

3 Connect them to resources

4 Coordinate their care

5 Empower them to self-advocate

6 Advocate for system change

7 Here’s what else to consider

Case Management

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How can you advocate for underinsured patients?

1

2

3

4

5

6

7

1 Assess their needs

2 Educate them on their options

3 Connect them to resources

4 Coordinate their care

5 Empower them to self-advocate

6 Advocate for system change

7 Here’s what else to consider

Case Management

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