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June 2012 VOL 3, NO 3

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In the News, Patient Education and Assistance

www.PatientAdvocate.org PAF – PATIENT ADVOCATE FOUNDATION

Lillie D. Shockney, RN, BS, MAS, ONN-CG 

The Patient Advocate Foundation (PAF) states that their mission is to provide effective mediation and arbitration services to patients to remove obstacles to healthcare, including medical debt crisis, insurance access issues, and employment issues for patients with chronic, debilitating, and life-threatening illnesses.

There are many services and programs offered to patients via PAF, and today we highlight one of particular pertinence to oncology nurse navigators: case management.

PAF’s professional case managers and attorneys specialize in mediation, negotiation, and arbitration to advocate on behalf of patients facing specific issues with their insurer, employer, and/or creditor regarding access to care, insurance, job retention, and/or debt crisis matters relative to their diagnosis of life-threatening or debilitating disease.

In addition to direct case management assistance, PAF provides the programs and partnerships listed below:

VIRGINIA CARES UNINSURED

Program—read more for those of you in the state of Virginia

Virginia Cares Uninsured Program (VCUP) is a collaborative effort between PAF and the Commonwealth of Virginia to provide dedicated case management services to individuals throughout the state of Virginia who are diagnosed with a chronic, life-threatening, and/or debilitating illness and who are experiencing access-to-healthcare issues. VCUP case managers provide assistance to Virginians requiring access to care, medications, and transportation for treatment, as well as issues involving insurance appeals, benefit exclusions, and copays.

Case managers assist patients with applying for, expediting, and appealing Social Security Disability Insurance (SSDI), Supplemental Security Income (SSI), Long-Term Disability (LTD) and/or Short-Term Disability (STD). They negotiate funding and/or insurance coverage to access medical devices, surgical procedures, and medications. They also arbitrate with facilities to obtain medical discounts and/or write-offs for services. Case managers also mediate access to free or reduced medication, nutrition, housing, utilities, and free or reduced transportation and lodging for patients who must travel for treatment. They also address COBRA, Medicaid, Medicare, and HIPAA plan issues relating to a patient’s diagnosis.

PAF/AMERICAN CANCER SOCIETY PARTNERSHIP

PAF has partnered with the American Cancer Society to provide case management services to patients nationwide who have been diagnosed with cancer or are being screened for symptoms of cancer. PAF provides extended services to patients experiencing healthcare issues to include insurance, debt crisis, employment, and/or out-of-pocket expenses related to cancer diagnosis and treatment.

The dedicated PAF case managers assist patients with insurance appeals, copays for chemotherapy treatment and medications, transportation to and from treatment, debt crisis in relation to the patient’s diagnosis, preauthorizations, enrollment and/or eligibility for state- and federal-funded programs (Medicare or Medicaid), billing/coding errors, and unpaid medical debt.

PAF/LIVESTRONG PARTNERSHIP

PAF has partnered with LIVESTRONG to provide direct case management services to patients nationwide who have been diagnosed with cancer or are in need of cancer screening. PAF provides extended services to patients experiencing healthcare issues to include insurance, debt crisis, employment, and/or out-of-pocket expenses related to cancer diagnosis and treatment.

The dedicated PAF case managers assist patients nationwide with insurance appeals, preauthorizations, billing/coding errors, and assistance with unpaid medical debt to include copays for chemotherapy treatment and medications. PAF assists the uninsured and under insured with accessing care and debt crisis situations due to a patient’s diagnosis. Case managers are available to assist patients with eligibility for state- and federal-funded programs such as Medicare, Medicaid, and Social Security Disability Insurance.

SURVIVORSHIP OF CANCERS IN UNDERSERVED POPULATIONS

PAF was awarded a grant by the Centers for Disease Control and Prevention for education and outreach to underserved populations. The diseases that fall under this grant are breast, cervical, ovarian, prostate, and colorectal cancers, along with melanoma (skin cancer).

The dedicated PAF case managers assist patients nationwide with insurance appeals, preauthorizations, billing/coding errors, and assistance with unpaid medical debt to include co-pays for chemotherapy treatment and medications. PAF assists the uninsured and underinsured with accessing care and debt crisis situations due to a patient’s diagnosis. Case managers are available to assist patients with eligibility for state- and federal-funded programs such as Medicare, Medicaid, and Social Security Disability Insurance.

Please take the time to visit this website and see the wealth of information and resources available to you and your cancer patients or reach them at the following address or phone number:

Patient Advocate Foundation

help@patientadvocate.org

421 Butler Farm Road

Hampton, VA 23666

Tel: 800-532-5274

Fax: 757-873-8999

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