Use of Patient Navigators Increasing

The Wall Street Journal reports that a growing number of professionals are helping individuals and families find their way through an increasingly complicated and costly health-care system. These specialists—known as patient navigators, health advocates and medical consultants—research treatments, grapple with bureaucrats, and process and appeal medical claims, among other tasks.

One such organization, Patient Navigator, based in Vienna, VA, was founded in 2009 and has expanded to 200 professionals. Fees typically run between $60 and $250 an hour. Various nonprofits offer similar advice for free, as do a growing number of hospitals, clinics, health insurers and employers.

Services vary. Some, including Healthcare Navigation of Shelton, Conn., primarily evaluate insurance options and resolve insurance and billing disputes. The nonprofit Patient Advocate Foundation in Hampton, VA handles appeals of claims denials and negotiates access to medications and medical services for those with chronic or life-threatening illnesses. Others aim to facilitate medical decision-making; for example, locating clinical trials, securing expedited medical appointments and helping those without a diagnosis find appropriate specialists. Some navigators serve a niche clientele, such as Medicare recipients or cancer patients. While some navigators have degrees in social work, nursing, or medicine, no specific training is required.

Many of these organizations are members of the National Association of Healthcare Advocacy Consultants (NAHAC). Members of NAHAC are bound by a code of ethics that, among other things, bars them from making treatment recommendations.

Under the health-care law, federal and state-sponsored health-insurance exchanges must hire navigators to help individuals and businesses evaluate and enroll in health plans.