AGING ICON

Aging Icon the song

Caryn Isaacs, OG, the original private professional patient advocate started using the term in 1976 on publications that advised employees about their benefits. The Health Line Directory, a model for Participating Providers, was published for 25 years, with an advertisement for The Patient Advocate which led to Caryn’s personal phone. She continues to work directly with people who seek answers that are not addressed by the established system. 

Way before that, Caryn worked in dental practices training families to care for their health.  For several years, she acted as an executive in a health insurance company, creating one of the first computerized systems to track and analyze physician services. Since many doctors looked to Caryn for advice managing their practice, she started a company that specialized in filling underserved patient needs.  From the early days of health reform, Caryn held various leadership roles including the creation of the Follow the Money Chart that was used to explain the health financing system.  Always believing that healthcare outcomes were directly related to people having appropriate information, Caryn co-founded a Physician-owned HMO.  Finding that the health system was becoming more and more complex, Caryn started GetHealthHelp, LLC to advocate for people needing help navigating the health system.  Aging Icon is Caryn’s latest project.  It is a social media and improvisational campaign to raise awareness and appreciation for the wisdom of accomplished adults regardless of the limitations imposed by society.

Caryn Isaacs’ book Aging Icon and her programs. engage groups, in a fun interactive way to find the Aging Icon in you.

February 17, 2024 Posted by Aging Icon | Uncategorized | Leave a comment

Will Patient Advocates go the way of the dinosaur?

“Greedy, Lazy and Cheap.” This was the title of a speech I gave to physicians back in the 1990’s when they had to decide if they would sign on to insurer panels. I pleaded with them to remember that if it looked too good to be true, then it probably was. But their greed clouded their judgement when the insurers told the doctors that they would give them an endless supply of patients, so that the doctors could just concentrate on being professionals and leave the business side to them. The physicians didn’t bother to read the contracts that said that the insurers could make any changes to the fees and terms at any time without notice. And they refused to hire people who could have helped them to understand the terms of the contracts. Even while the doctors would praise me for my interesting program, they ignored the warning as they marched off the cliff and lost not only their ability to set fees and define practice parameters, but even lost the title for which they had worked so hard, Doctor. Now they are known as Providers and their position as the trusted advisor to the patient’s health has been replaced by Physicians Assistants or Nurse Practitioners. No wonder people are turning to Patient Advocates to help them navigate the health care maze.

However, who is a Patient Advocate? I started my Private Professional Patient Advocate business in 2008 after using the title since 1976. Originally, doctors and hospitals paid for my services, but once the insurers took over their businesses, the ‘Providers’ and those paying for the insurance, mostly employers or Unions, were left hoping for the best or looking for lawyers. So, that’s when those who could afford it, looked for someone to help them when they couldn’t get the care they needed or found themselves stuck with unexpected bills.

Most advocates agree that over the past decade, few people knew that Patient Advocates existed. Also, there was no license or standard rate for their services. Just like the renaming and reassignment of roles for physicians, anyone could call themselves a Patient Advocate. Insurers and hospital systems took full advantage of the confusion and gave out these titles to advertise their customer service departments. Then, a group of Advocates got together and formed the Patient Advocate Certification Board. Here is the eligibility requirements for a person to call themselves a Board Certified Patient Advocate, which includes education, experience and a very difficult test. https://www.pacboard.org/eligibility Many nurses and social workers are adding the BCPA to their names after becoming frustrated with the limitations being placed on their decision making. Social Workers who have masters degrees and accept Medicare reimbursement make a fraction of what a Private Patient Advocate charges.

Just as the stakeholders in the payer world (when the health system was described as consisting of patients – providers & payers} used a bait and switch methodology to get people to accept that they no longer had doctors, there is a new effort to usurp the term Patient Advocate. A recent article in the NY Times praised the role of the Patient Advocate in the hospital setting. https://www.nytimes.com/2022/03/03/well/live/hospital-patient-advocates.html

Big pharma is promoting a Healthcare Advocate Summit. Notice the juxtaposition of the word Patient and Healthcare when talking about who or what is being advocated for. The website for the Summit states in their lengthy mission that “The Advocate is the connector between securing clinical treatment for the patient using the appropriate procurement methods that ensures reimbursement for their health care organization, all while offering emotional support to the patients.” This leads me to remember the same kind of verbiage that was used when managed care was trying to cloud their intent to steer patients to lower cost services.

I’ve spoken to a few of my fellow Independent Patient Advocate business owners who came out of the practice management world. We can understand that nurses, social workers and customer service people who work in various health systems (hospitals, insurers, professional organizations or government) might believe that adding a billing code for Advocacy will raise their salaries. However, we caution them to look at how managed care contracting worked for the doctors and for the patients.

May 22, 2022 Posted by Aging Icon | Uncategorized | Leave a comment

Join Us for Professional Advocates Networking

February 28, 2022 Posted by Aging Icon | Uncategorized | Leave a comment

2022 Changes for the Better ?

Seniors are buzzing about the news that social security is giving seniors a raise. The problem is that other things are going up and the raise doesn’t come near to covering them all. Groceries, gasoline, home heating and drugs are just a few of the things we can expect to pay more for in 2022. Many people are looking at Medicare Advantage plans to save some money on health costs. Advantage plans are advertising plenty of extra perks like no premiums, transportation, dental and vision care to lure seniors away from traditional Medicare. That’s the carrot approach, offer a treat. Then there’s the stick approach. NYC retirees are getting the stick. Either accept the Advantage Plan or opt out and pay a steep penalty.

Here is an article from Robert Intelisano, CSA, CLU, LUTCF aka The Insurance Doctor, Certified Senior Advisor

NYC Workers, Supplemental vs Advantage!

The BIG WINNER here is New York City, who has found some type of loophole and passed on the plan subsidy to the Federal Government.  We estimate the city will be saving about $200 per person.  I would not be surprised if there was some type of “class action” lawsuit against the city over the next 6-18 months. 

For hundreds of thousands of retired NYC workers, a big choice is looming during open enrollment!  Whichever path you take will determine how you get your medical care and how much it costs out of your pocket. The choice is not as simple as it appears.  Most people would ask, which one is better?  Answer is, “It Depends!”

The first decision is; do you want to enroll in Federally run “original” Medicare, or select a “Medicare Advantage” Plan?  For foodies, think of it as ordering a “price fixe” meal (Medicare Advantage) where most decisions are already made for you or going to “the buffet” (original Medicare) where you need to decide for yourself what you want.

Both options will cover your “pre-existing conditions” and you will be able to obtain coverage for prescription drugs.  Differences begin with going to the doctor.  Original Medicare allows you to choose ANY doctor that accepts Medicare.  A Kaiser Family Foundation survey said that 93% of primary care physicians accept Medicare.  If you are looking for a new physician, research needs to be done to see which doctors are accepting “new” Medicare patients. 

Under “Medicare Advantage,” you will be joining a “private health insurance plan” probably similar to what you had when you were working.  Most of the common private insurance plans are HMO’s (In-network only Health Maintenance Organizations) or PPO (in and out of network Preferred Provider Organizations).  Keep in mind, with the private plans you will likely need to see your PCP (primary care physician) first then get a referral to a specialist, which is more time consuming.  This can also be an issue if you travel out of state and have a health issue as you will likely need to go out of network which will cost more out of your pocket.

See my 5 top tips below on how to address this new “predicament!”

1. Do Research:  Familiarize yourself with what Medicare Part A (hospitalization), Part B (physician and outpatient services), Part C (A Medicare Advantage Plan),  Part D (prescription drugs) mean. 
2. Speak to a Licensed Professional:  Insurance brokers must get “re-certified” every year, which consists of passing multiple tests of their knowledge.  A trained Professional can guide you much more easily than trying to do it yourself.
3. Don’t Wait Until the Last Minute: Waiting until the December 7^th open-enrollment deadline increases the probability of making the incorrect decision.  Doing “nothing” is a decision as you will automatically be put into the Empire Blue Cross (or Emblem) plan.  Many people will see “FREE” and choose that option, which could lead to higher co-pays and more money paid “out of pocket!”
4. Check With Your Preferred Doctors:  Make sure your doctor still accepts Medicare, which is frustrating for doctor’s offices to deal with the Government, delaying reimbursements and many other issues to deal with.  It is also important how much you utilize benefits and how many prescriptions you might be on.
5. Determine Your Need for Dental, Vision and Other Services:  Under Medicare Advantage, you will get all of the services you are eligible for under original Medicare.  Some Medicare Advantage plans offer additional services such as vision, dental and some gym memberships.  The Government has been adding some services over the years like home improvements (wheelchair ramps), transportation to doctor offices and getting meals delivered.

Remember, with the Advantage plan the insurance company and your doctor make your health decisions whereas with the Supplemental plan it is YOU and your doctors making these decisions!

Whatever you do, take time to do the proper pre-planning as these choices can have a big effect on your next 12 months of care. 

You can see more about Robert Intelisano at https://insurancedoctor.us/

November 9, 2021 Posted by Aging Icon | Uncategorized | Leave a comment