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An article titled “Health-care advocates do the job if you have the money, Experts will guide you through tricky health-care maze” appeared on the front page of the June 22, 2008 edition of the Chicago Tribune. It was written by Tribune reporter, Judith Graham.
I once spoke by phone with Ms. Graham, in an attempt to tell her about my experience serving as a health care advocate on behalf of my folks. However, Graham was not interested. I had explained to Graham that I was not seeking publicity, but that I wanted simply to convey my experience. The aforementioned article is a good example of why I thought that a reporter would be interested in learning about the wrongdoing that I have encountered.
There is not really a “health-care maze”. If I was able to figure it out, then any reasonably intelligent person should be able to figure out how to handle any health care issue. Doing so is time consuming, but not that complicated.
The problems that I ran into were not due to a “maze”, but rather because my folks' Medicare managed care provider used deceit to dodge the Medicare managed care regulations. The regulations are supposed to be enforced by the Centers for Medicare and Medicaid Services; they have been established to prevent the Medicare managed care policyholders and providers from placing their bottom lines above the well-being of the beneficiaries. In our case, CMS has given the provider its approval for violating the regulations.
According to Graham, “The field is known as "health-care advocacy”, and services typically assist with everything from resolving insurance disputes to researching treatment options to connecting people with medical resources.” This is all done for a fee, ranging anywhere from “$395 a year” at one company, to “$200 an hour” at another.
One of the companies mentioned is “an upscale solution, serving as the health-care equivalent of an exclusive, high-end private banker for more than 3,600 clients.” Graham writes that, “Today, at least 20 families on Forbes' list of the richest Americans are clients, paying from $10,000 to upward of $50,000 a year for a PinnacleCare membership.”
Graham provides an example of a man who purchased the services of PinnacleCare for his wife and three adult children. She writes, "Late last year it cost $41,000 a year for a VIP package for himself and his wife, ensuring that a top-notch physician would oversee all their medical needs; $30,000 a year for a package focused on healthy living for his three adult children and their families; and $21,000 for a one-time fee to compile comprehensive electronic medical records for everyone.
In all, that's $92,000 paid on health-care advice by this 66-year-old entrepreneur before a dollar was spent on medical services actually delivered."
These companies advocate because they make money doing it. I advocate because it is my folks that need the help. I do not know what PinnacleCare does that I have not done, but I sure would like to find out what they do for $50,000 a year.
I wonder if my folks had been wealthy, if that would have made a difference in how the provider chose to abide by, and how CMS chose to enforce, the CMS regulations.
If Graham had bothered to take a little bit of time to learn about my experience as a health care advocate, she might have wondered the same thing.
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Note:
On June 22, I sent an email to Ms. Graham, in which I reminded her that I had tried to tell her about some of my experiences, but that she had not been interested. She wrote me back almost immediately, and stated that she has talked with a lot of people, and that she was sorry if she had offended me.
