Patient Advocate Services

We offer are patient advocate services, because we understand how much it can hurt when an insurance company denies your claim or a request for medical care. It can seem crazy that an insurance company can deny something you really need and your doctor recommends. We know understanding health insurance can be difficult even under the best of circumstances.  When you add a difficult medical condition, an uncommon treatment or other conditions, it can seem like a maze you’ll never figure out. It also feels at times like the insurance company has stacked the odds against you.  However, it’s often not as bad as it looks.  The challenge is the insurance company has much more experience at dealing with claims and appeals than any policy holder.  You might do one appeal in your lifetime; the insurance companies do thousands a day.  We work to balance the odds so you have a chance and streamline that difficult process by working on your behalf.

As patient advocates, we fight to clarify diagnosis and treatment options, help you understand medical options, access to quality healthcare, negotiate coverage with health insurers and providers, communicate constructively with employers, find financing options, coordinate with healthcare and other service providers; and build our clients  personal advocacy skills, as needed.

Whom do we serve?

We serve patients with life-threatening and serious illnesses and their families.

What do we do?

When a prospective client contacts us, it is because they are experiencing an illness or injury and need guidance to sort out and navigate the medical and health insurance mazes.  We know how to find the language in your health insurance coverage the insurance company may have overlooked or even ignored.  We know what questions to ask and how to ask them in ways that unveil the real reason the insurance company denied your claim or request for benefits.  We know how to talk with insurance company staff to create a path to get your benefits approved, and, importantly, we succeed at it.

Soter’s patient advocate services may involve:

  • Helping you understand your medical diagnosis and treatment options.  Sometimes this sounds like translating medical terminology into English.
  • Helping you find the best doctors and hospitals for your medical condition.
  • Coordinating hospital admissions and continuity or care arrangements for you.
  • Negotiating with your insurance company or companies for benefits for the treatment you need.
  • Negotiating with your provider to accept your benefits or other financial arrangements.

How much will it cost?

We offer fixed cost services in most cases.  Our standard service packages look like this:

Health Insurance Evaluation
 
This initial service involves talking with you and looking at the terms and conditions of your health insurance policy, denials from your insurance company and other documents that are relevant to your personal situation.  After this review, we discuss with you the potential for success of further efforts on your behalf.  If we believe you have a strong potential for getting insurance coverage for your situation, we’ll tell you.  We’ll also tell you if we think your chances are not strong. With that information, you can make an informed decision about what to do next.

Insurance Coverage Advocacy
 
Soter Healthcare believes we have a responsibility to see our insurance advocacy work through to its end for you.  Consequently, we divide the fee you pay us in two parts. The first part is due when we start working on your behalf. We quote this amount for you before we begin the work, so you know what the appeals and related processes will cost. We question your insurance company, look at the ways they made their decision, negotiate with them for the benefits for which you are eligible, and submit appeals to the insurance company and external review organizations. We also engage regulatory agencies when they can provide assistance with your case. 

The second part, which we refer to as a Success Fee, is typically $800 and is only due if we succeed in getting benefits approved for you.  This is an important distinction from other advocacy firms that bill their entire fee up front, regardless of whether they succeed. It gives us the equivalent of skin in the game, so it’s not just the effort that matters.  You only pay the full fee if we succeed for you.

Additional Fees

Additional fees are rare; however, they do happen at times. As an example, we are typically able to send appeal documentation electronically.  If that is not possible, we will bill the costs of producing and submitting paper copies.  We will make every effort to make you aware of these expenses ahead of time.  

Please note that the fees described above are for a standard services program and may vary if special circumstances or services are involved.  In those cases, we still offer fixed cost programs, but the amounts may be different from those shown above.

 
Contact us today to apply for Soter’s advocacy services.