Insurance company/Nurse Advocate - is this a real thing?

pcranky

After my first round of bills hit the insurance (United Healthcare/Oxford) company (tests and surgery) I received both a phone call, and a nicely-designed brochure offering the services of a "Nurse Advocate" through their Cancer Support Program.

The brochure states that as part of my benefits I have a specialized cancer nurse to help me through my treatment -- giving me "answers you can trust and support you can count on".

Further it says the program helps their members "understand their cancer and feel empowered to make the best decisions for their health"

Is this a real thing designed to help or something the insurance company has set up to make me spend less money? I know I sound paranoid but I'm somewhat mistrustful of the Insurance company's motives. Does anyone have any experience with this?

Thanks in advance,

LeesaD

I have United Healthcare / Oxford as well. I would get those phone calls and letters from the nurse advocates as well and I ignored all of them and never called back or responded. I took the phone calls same as you suspect ...that they wanted me to use offices/ doctors/ testing facilities that cost less money for them even though all my providers were in network anyway. They would call usually after a test was authorized and leave a message saying we want to help you pick a facility. They finally stopped calling eventually. Also with so much going on and so many doctors and tests it was so overwhelming in the beginning, the last thing I needed was someone else in the mix. Maybe I am being cynical but I took them same way as trying to save themselves money. And really other than that I have nothing but wonderful things to say about United Heathcare/Oxford and the coverage I have received. They have covered everything. Living in NY I feel has also helped as NY State law is very good for breast cancer coverage and what is required to be covered. I've read on here members having issues with getting procedures and medications approved and I feel extremely blessed that I have been fortunate as far as insurance goes.

pcranky

Thank you! I'm glad to hear you say that.. both for trusting my instincts, and that Oxford covered everything. (everything is still outstanding at this point)

I'm also in NY, and feel fortunate to live here with this going on. Lots of options.

LeesaD

Yes they’ve been just great. Very easy to deal with and really no major issues and the very minor ones I did have were addressed and taken care of immediately. Best of a luck to you! If you need anything please reach out.

rdeesides

I have UHC but am in California. I got the same call but haven’t responded either. I agree that UHC is great, and California laws have helped me so much. I was able to take 6 months off at diagnosis and take state covered STD.

pcranky

Thank you so much!

SummerAngel

I had Blue Cross at the time of my diagnosis and also received these calls. I did take them and spoke to the nurse advocate about 4 times total. She was very kind, gave me her opinion if I asked for it, and never tried to sway my decisions or places of treatment.

I also had a nurse advocate assigned to my by my chosen hospital, as they have a breast cancer treatment center. She was great, gave me all sorts of local information and came to see me after my surgery.

gb2115

It's a real thing. Just like the pregnancy programs through the insurance companies...once they figure out you are pregnant it generates a phone call. I actually found that pretty helpful at the time. I had a ton of questions and sometimes it was easier to get United Healthcare on the phone that it was to get my OB's nurse to call me back.

I think UHC sent me something in the mail about cancer but I ignored it. I didn't want to talk with anyone else. My nurse navigator through one of the local hospitals was extremely helpful and was the only resource i really needed.

Capecodgirl

I had United Health Care at diagnosis. They called offering the same program, and I said yes, I will talk to the nurse advocate. They transferred me over and I was left on hold for 10 minutes. I finally hung up. The reached out to me many times after that but I ignored it. Our insurance switched recently to Bcbs, but I had to call United about a past claim. While I was talking to them they again offered the nurse advocate program, and I had to remind them I no longer am insured with them.

On a side note I feel that United is better for me than Bcbs with regard to my coverage. I wish I was still with them.

Peacetoallcuzweneedit

I have Blue Cross and am in California...and I too had the phone calls, when I was diagnosed. I spoke to the nurse and told her "um is your alliance with Blue Cross or the patient?" I asked her about her schedule, what the point of all the phone calls was supposed to be, and what if I didn't want the help could she at that point just stop calling....? I spoke to mine three times, and she was the one that said, "you need to get a colonoscopy. Go to your doctor and advocate for a referral." I knew that it was not uncommon for breast cancer patients to have risks for other primary cancers and that colon cancer was one of them. I was 47 at diagnosis. She said, make sure you get that done sooner vs later. That was her advice, and I took it...which was good, because there is something in my colon - not cancer thank God! She called one time just to check on me and chat....she wondered if I was sleeping, and if the people around me were being supportive. All in all a good experience...never pushed facilities or insurance related issues - just literal health discussions.

Puzzlewoman

Yes, I have UHC too, and also have this. However, I wasn’t made aware of it until after my treatment was already over. I did talk to the nurse (they setup an appt for her to call me), and listened to all she had to say. It might have been helpful if I had known in the beginning!

Lula73

I have BCBS and it was offered to me too. I politely declined as this wasn’t my first rodeo with the big CA (although first for BC). There are thousands of people out there that are diagnosed with cancer, heart failure, kidney disease, diabetes, etc that have no clue what they’re supposed to be asking, why their dr has told them to do or not do certain things, what the diagnosis really means, etc. The nurse advocate program is really designed for those individuals to give them an advocate. Us ladies here on BCO tend to be the exception: we’re doing our own research, we’re being our own advocate, etc. We can still benefit from the program, but we may not benefit from it as much as those that aren’t wired like we are. It’s nice to have the option if we need it.

BellasMomToo

I also have BCBS and it was offered to me too. She called my landline several times and left messages. I would return her call and ask her to call me on my cell. She never did. Fortunately I didn't need her assistance but it was irritating that she never returned my calls.

SimoneRC

I am UHC. I am medically savvy. The gentleman who phoned could not pronounce the word mastectomy. I asked him what the point of his call was. He said to help guide me through treatments,etc.... Given that A). My/spouse/many M.D. friends personal history and understanding of medicine . The fact that a major cancer center was providing my care C). The fact the man from the insurance company could not even pronounce the word mastectomy, I asked that UHC please not waste my time with these unsolicited calls as my healthcare team and I had my treatment plan firmly under control. I assured him my that if the fine doctors at major cancer center could not figure it out, we would call them;-). For me, this was not a useful service

Lumpie

In my roll as a nurse, I have worked with such advocates (in the setting of obstetrics vs. cancer). I have found most to be the "real deal." I love Peacetoall's advice that you ask very pointedly (and nicely, of course) about this person's roll, credentials, experience and allegiance. If the person is a licensed healthcare professional, they have ethical obligations to not do anything that might harm you and to be honest about aspects of treatment. That is not a guarantee but it's something. The advocates I worked with were always experienced nurses. Here are the pluses I observed: they know their area of practice and can answer care related questions and help the patient formulate other questions they want their doctor to answer; they are knowledgeable about standards of care; they help patients stay on track with care (more valuable to patients who were having a hard time following the plan of care or were a little ...scattered...); if someone on the provider side "dropped the ball" in arranging for the next step in the care process - or if there were simply a miscommunication - sometimes the advocate could help get things back on track. The advocate could ...um... advocate! that the insurance company pay for a non-standard therapy if they understood why the patient needed it; the advocate could help resolve billing/payment issues. I personally observed good advocates doing all of this. I also observed some who didn't seem to do much. I was never aware of any doing anything to undermine patient care. Just my "2 cents" but I'd kind of think it might be worth having this person "on your team" if it's not too burdensome to keep one more person in the loop. Just for the possible help with billing issues if nothing else.

WC3

I generally regard these programs as ways for insurance companies to look appealing to potential customers and get info from me for their benefit. That's not to say they can't help you avoid certain problems or emergencies, but if they had my best interest at hand they would not have first insisted I get sick before they approved the Neulasta.

There are some instances in which an insurance company does make a good resource as an advocate; for example when you have some out of pocket cost, they can tell you the cheaper facilities and pharmacies...they keep a list because cheaper for you is cheaper for them.

Anonymous

I had a oncology nurse advocate with our insurance company. I spoke with her briefly every couple of weeks. She offered me advice and helped me with some questions I had on various different topics.

DebAL

WC3, I was in your boat. Neulasta DENIED. Onc went peer to peer DENIED. I went home pissed on a Friday. Called my husband and said don't call me, I will be on the phone all day fighting for this. I was on the phone and on hold for quite awhile but I must say with kind people that seemed to care. Wrote an appeal letter. Demanded a response. Got a phone call EASTER SUNDAY. APPROVED. First chemo was the next day. Otherwise neulasta would have cost me $32,000. Like you said, they will pay to be hospitalized for neutropenic fever and then approve neulasta after that. Makes no sense. I feel for the elderly and others that don't know to advocate for themselves. My oncologist said that was the first time ever in her practice that a patient won an appeal over a peer to peer. It usually stops there after peer to peer is denied because the patient may not think to fight. Sorry, my training as a nurse served me well. I think I know what will keep me busy when i retire lol I will never know for sure. but I got through chemo with NO side effects. I'm convinced neulasta helped. WC3 i hope you are doing well!

pajim

I have BCBS also. I spoke with the nurse advocate a couple of times. She knew her stuff but wasn't really helpful to me as I work in a medical office and had lots of people of whom I could ask questions.

She'd have been very helpful if I was having trouble coordinating things, etc. It may not be suitable for the kinds of people who find these forums -- we tend to be a certain breed of cat -- but they can be helpful for those who need it.

FarAwayToo

I have Cigna, and have been talking to a "nurse advocate". I ignored several last calls, because I found zero value in our previous conversations. She basically always asked for updates on my treatment and how I was feeling, but had no answers to any of the questions I had. Her usual answer was "ask your doctor(s)". Gee, thanks!

HersheyKiss

FarAwayToo, I have Cigna as well. I found their "nurse advocate" to be unimpressive. We'd set a day/time for a phone conversation, and she wouldn't call. Or she'd call me on the wrong day. She ended up leaving me a voicemail that if we didn't speak, I'd be dropped from the advocate program. I guess I was dropped, because I never heard from her again.

illimae

I had them with United and BCBS. I am careful with what I say but found both to be helpful and genuinely interested. Neither of they ask personal question or pry, just how are you feeling” and “can I help you with anything”. I had a problem with an approval while under United and I complained to her about it and she got everything fixed the next business day.

WC3

DebAl:

I'm on the chemo trail (I've decided it is much like the old computer game "The Oregon Trail"), but I'm doing ok, thanks :-)

gardengypsy

pcranky,

My nurse advocate through BCBS was amazingly helpful. After an initial benefit denial, I had to do an appeal. (I racked up a $60,000 out-of-network bill!)

She guided me through the entire process and it resulted in a successful outcome.

Good luck!

BPXDomino

I've been working with one through Cigna since I was first diagnosed, and I have found our chats to be valuable. She helped me understand all of the benefits available to me, including how to use their in-network wig vendor, and checks in every two weeks. She has good suggestions for helping me navigate the side effects of chemo (including going for IV fluidss multiple times a week - something that definitely increases the insurance costs, for sure, so I was surprised to hear her recommend that). She was the first to reach out, but I've also been contacted by nurse advocates at the hospital where I had my surgery and also at the oncologist. I have not worked with either of them only because I found the insurance company advocate helpful enough.

sh2015

I had UHC when I was diagnosed and through my mastectomies. They were great! Since I can no longer have mammograms I'm trying to figure out what to do every year to keep this is check. UHC allowed a chest MRI to verify that there was no cancer. My tumor was very close to my chest wall. My current insurance is denying this as they say there is no reason for one!

So....before I had cancer I'm allowed to have a mammogram every year to make sure I don't have it....but since I've had cancer they don't want to do any yearly test to make sure it doesn't come back! What is wrong with this??

I don't know if there is any other test that will work. Will an X-Ray show any cancer? Will anything else work or is the MRI the best thing? My Dad passed from lung cancer and also had Colon cancer with part of his colon being removed. I have had a colonoscopy and 18 months later had polyps that were pre cancer. I will now have a colonoscopy every 18 months. Is this not enough reason to be checked every year?