How And Why I Became A Patient Advocate

My first gig as a patient advocate occurred about 20 years ago and it was completely happenstance.

A friend of my wife’s had to go on disability from her teaching job because some students had gotten into a fight and she was injured trying to intercede.

However, her physician was not releasing her medical records, despite her making numerous requests that he do so. Without those records, she could not make a valid disability claim. My wife asked if I could help.

I made one phone call. I told the doctor’s office manager very politely but rather bluntly if the records weren’t released immediately, I would file a complaint with the state’s medical board.

The records were immediately released. I probably annoyed an office manager, but since I helped someone else who desperately needed it I could care less.

I also tried not to read too much into the cultural delicacies of that particular situation. But the fact my wife’s friend was a woman of color and I could serve as the illustration for the dictionary’s definition of “white guy” probably played a role. Despite some trying to insist racial bias does not exist anywhere in America, it is definitely extant in its healthcare system.

I also do not particularly care for the feelings of medical officer managers, or that their bosses are too busy “saving lives.” Just because the patient is not in your office does not mean their life you are supposedly dedicating to saving ceases to matter.

A few years after I assisted my wife’s friend, I began working as a patient advocate professionally. My issues with obtaining medical records have persisted, but my technique has been refined.

These days, I send a certified letter labeled “personal and confidential” to the doctor, explaining that their staff’s refusal to release medical records is a HIPAA violation (which it is). I also attach three of the largest six-figure fines recently issued to doctors by the U.S. Department of Health and Human Services for failing to release patient records. There are times when you could literally set your watch to how rapidly my request is honored.

How did I wind up with such a bluntly dogmatic approach to patient advocacy? It’s due to my other career: Decades as a journalist covering the business of healthcare from pretty much every conceivable angle. The thousands of articles and interviews I have written and conducted over those years has been great training to understand how health insurers and hospitals operate, how doctors maximize revenue, which government agencies are proactive or useless, which regulations have teeth, and so on.

Journalists also have a universal credo: If your mother says she loves you, check it out. The skeptical autonomy granted journalists makes for good fact-finding as an advocate.

As a journalist, I also have to practice objectivity. And as a brief aside, how that has been perceived by the public has been one of the most infuriating things about my longtime profession.

Journalists have been accused (primarily by politicians and political trolls) of liberal bias, etc. that supposedly colors their coverage. This is denied, of course, and the denial is accurate – to a point.

Here is the unvarnished truth: Journalists do have biases, like every other human. There are people they cover whom they abhor, for both rational and irrational reasons. But as professionals, they put that bias away and do their work. I would drop dead on the spot if an editor for the New York Times or another media organization actually said something along those lines, but that is the truth. Doctors, lawyers and all sorts of other professionals may despise their clients. But a professional does the same job as they would for everyone else and keeps their opinions to themselves.

As an advocate, I do not have to be objective. And it’s not hard to work up empathy and passion for someone who is broke but cannot get care, or is dealing with a five-figure medical bill they thought their insurance would cover, etc. And when I obtain a resolution favorable to my client, it is not hard to feel vindication – if not joy – for achieving such an outcome.

And not only does my journalism background inform my practice, it can work the other way.

“How did you find this out?” an editor asked when I reported that the hospital in Vail, Colo. was in-network for those who had insurance with Elevance Health – except for a single operating room that was not in-network.

“Advocacy work,” I responded. That discovery got my client out of a $19,000 bill.

That editor was aware I practiced patient advocacy on the side, and I went so far as to inform him if I thought potential conflicts of interest arose. He was eventually replaced by another editor, who was less charitable about my side business.

I disagree. I do not profit from the businesses I cover as a journalist, and I rely on systems that are open to anyone who has a healthcare issue: Emailing and calling providers, filings appeals and grievances. If it is journalistically unethical for me to rely on them as an advocate, would it not be the same as an individual health plan enrollee?

And quite frankly, it is more important I help people enmeshed in our hopelessly complex and avariciously greedy healthcare system than write about the eight-figure pay packages the captains of that system enjoy.

Most of my income is still derived from my work as a journalist, but I am making the push to become an advocate full-time.

To those who are reading this, who may have medical or billing issues – or know someone who has – I hope you are able assist me in reaching this goal.