Which kind of advocate do you actually need?
There are four common ways to get help navigating healthcare, and they differ mainly in who pays the advocate. A hospital patient advocate is employed by the hospital, a plan case manager is employed by the insurer, an independent advocate is usually paid by the patient out of pocket, and a Medicare-covered advocate is paid by Medicare for a defined service. Each is useful. Knowing who employs whom tells you what each can do for you.
| Hospital patient advocate | Insurance plan case manager | Private independent advocate | Careway | |
|---|---|---|---|---|
| What it is | A patient relations or advocacy office employed by the hospital or health system. | A care or case manager assigned by a health plan to certain members. | An independent professional a patient or family hires directly. | A personal advocate supported by a care team that includes a physician. |
| Who pays | The hospital, as part of its own operations. | The health plan. | The patient or family, typically out of pocket at an hourly rate. | Medicare, through Medicare's care management programs. |
| Who they work for | Helps resolve concerns and complaints within that hospital, while employed by it. | Coordinates care and benefits within that plan, while employed by the plan. | Works only for the patient, with no institutional employer. | Works for the patient across every doctor, hospital, pharmacy, and insurer involved. |
| What it covers | Issues arising inside that hospital or system: complaints, service problems, discharge questions. | Benefits, covered services, and care management programs offered by that plan. | Whatever the family hires them for, across any provider or insurer. | Coordination, coverage and appeals, prescription costs, records, transportation, and community resources. Not clinical decisions, which stay with your doctors. |
| Availability | Available during a stay or an episode of care at that hospital. | Assigned by the plan, usually to members who meet its criteria. | Available to anyone who can pay privately; not billed to Medicare. | Ongoing, for eligible Medicare patients in California, Florida, Michigan, Ohio, and Wisconsin. |
Sorting out the differences
The hospital's advocate is employed by the hospital and helps with issues arising there. A Careway advocate works for you across every organization involved in your care, including other hospitals, specialists, pharmacies, and your insurer, and continues after a stay ends.
Many people have both, and they do different jobs. A plan case manager coordinates benefits and programs within that plan. An advocate works for you across the whole system, including when you disagree with a coverage decision.
Private advocates are typically paid out of pocket at hourly rates, and some families prefer that arrangement or need help outside what Medicare covers. If you are Medicare-eligible and in a state Careway serves, the covered route is worth checking first.
No. You keep every doctor you have. An advocate works alongside your existing care team and does not make clinical decisions or replace anyone in it.
Talk to someone who can take this on
Checking whether you qualify takes a couple of minutes. If we are not the right fit, we will tell you plainly.
Covered by Medicare. If you have a supplemental policy (Medigap) or Medicaid, your standard coinsurance may be fully covered.