Frequently Asked Questions From Our Patients
- What is it that your organization does?
- Are your services free?
- How can I get case management assistance?
- Do you offer financial assistance?
- Can you help with transportation?
- Where can I get financial assistance for my living expenses, such as rent, utilities and food?
- How can I get help with funeral expenses?
- How can I get insurance if I have a pre-existing condition?
- Once I become eligible for Medicare how long do I have to enroll in Medicare Part D?
- How can I get assistance with the 20% that Medicare does not cover?
- With Medicare Part D plans, are there any cost breaks for married couples?
- If you have TRICARE for Life, do you have to enroll?
- What is the difference between SSI and SSDI?
- I need assistance with applying for Social Security Disability (SSDI).
- How can I get my Social Security Disability application expedited?
- I have not heard anything from Social Security regarding my case for SSI/SSDI, can I check the status?
- Why was my Medicaid taken away when I became SSDI eligible?
- How can I get Medicaid?
- How can PAF help with medical expenses?
- I have an HMO and want to go out of network. What are my rights?
- How should I appeal a denial by my insurance company?
- How do I get co-pay assistance for my medications, radiation, chemo, and medical supplies?
- If I change jobs will I lose my ability to elect new health care coverage?
- I feel as though I am being discriminated at work because of my illness. What should I do?
- I need to take time off of work due to my illness. Is my job protected?
- I am uninsured and cannot afford my medication. Is there any assistance available?
- I've just been diagnosed with cancer, I'm uninsured, what do I do now?
- How can I get brochures from PAF?
- Can I participate in a clinical trial?
- How can I relate my concerns to my local congressman?
- Can you help me find a doctor?
- How can I get involved with patient advocacy?
- Can my doctor refuse to provide me with my medical records?
- Do you provide medical advice?
- I am not a US citizen. What can I do to get treatment in the US?
- How can I apply for a PAF scholarship?
What is it that your organization does?
Patient Advocate Foundation is a national non-profit organization that serves as an active liaison between the patient and their insurer, employer and/or creditors to resolve insurance, job retention and/or debt crisis matters relative to their diagnosis through case managers, doctors and attorneys. Patient Advocate Foundation seeks to safeguard patients through effective mediation assuring access to care, maintenance of employment and preservation of their financial stability.
Are your services free?
Yes. Patient Advocate Foundation provides case management services, educational materials and live chat option at no charge to patients.
How can I get case management assistance?
If you have a chronic, debilitating or life threatening illness and would like to have direct communication with a member of our Case Management Department, please call our organization at 800-532-5274. We have a live call answering system. We have access to a wide variety of resources and can offer intervention if necessary.
Do you offer financial assistance?
We do not offer direct financial assistance. Please refer to our website www.patientadvocate.org for resources that may benefit you. From our home page, click on Money Matters under 'Resources at PAF.' Choose the "State by State Financial Resource Guide." Select your state if you wish to see what resources may be available to you. If you are in need of copay assistance, please contact our Co Pay Relief Program at 1-866-512-3861.
Can you help with transportation?
Please refer to our website www.patientadvocate.org for resources that may benefit you. From our home page click on Money Matters under 'Resources at PAF.' Choose the "State by State Financial Resource Guide." Select your state if you wish to see what resources are available in your area.
Where can I get financial assistance for my living expenses, such as rent, utilities and food?
Please refer to our website www.patientadvocate.org for resources that may benefit you. From our home page, click on Money Matters under 'Resources at PAF.' Choose the "State by State Financial Resource Guide."
How can I get help with funeral expenses?
There are limited resources for funeral expenses available. If your loved one had no assets, and was eligible for public assistance, you would need to contact either the Social Services/Medicaid case worker or Social Services General information to inquire about indigent funeral assistance. If he/she was a Veteran, you would need to contact the Veterans Administration to inquire about available benefits. You can also contact the Social Security Administration for assistance. If you are unsure of how to proceed, please consult with the funeral director of the funeral home. They often have access to information regarding the availability of state or local assistance.
How can I get insurance if I have a pre-existing condition?
You may want to visit www.healthinsurance.org/riskpoolinfo to determine whether the state in which you reside offers a State Comprehensive Health Insurance Program also called a “risk pool”. These programs offer access to health insurance for patients who are unable to obtain coverage elsewhere. If you have the option of electing COBRA through an employer plan it is best to consider this option to prevent a lapse in coverage. If you have a spouse with an employer sponsored group health plan you can enroll into that plan outside the open enrollment period because of your “qualifying event” (loss of coverage through your own employer).
Once I become eligible for Medicare how long do I have to enroll in Medicare Part D?
3 months prior and 3 months post effective for Medicare
How can I get assistance with the 20% that Medicare does not cover?
Contact your local hospitals and ask to speak with a social worker or financial counselor to find out if they have any charity care/financial hardship programs. Your other option would be to make payment arrangements with a physician willing to see you on that basis. For medical bills already incurred, you will need to find out if that facility/provider has a financial assistance program. If you are in need of copayment/coinsurance assistance, please review CoPay Relief’s website (www.copays.org) to see if your diagnosis qualifies.
With Medicare Part D plans, are there any cost breaks for married couples?
No. Each spouse pays separate premiums, deductibles, and co-pays for prescriptions and will reach each level of coverage according to his or her own drugs costs over each calendar year.
If you have TRICARE for Life, do you have to enroll?
Tricare benefits will not change at this time. If these benefits should change, you will not be penalized by Medicare for late enrollment since you had credible coverage. This also holds true for Department of Veteran's Affairs (VA) and the Federal Employee Health Benefits Program (FEHB).
What is the difference between SSI and SSDI?
Social Security Disability has two programs. The first, Social Security Disability Income (SSDI), is based on a worker’s previous earnings history. Please refer to your Social Security Disability estimate document sent yearly, prior to your birthday, for what your benefit will likely be. Supplemental Security Income (SSI) is for patients who have never worked or are very low income. SSI offers a flat benefit of approximately $545.00 per month depending on geographic location.
I need assistance with applying for Social Security Disability (SSDI).
You may want to visit the Social Security Administration's (SSA) website: www.ssa.gov to learn more about the Social Security Disability process. Please refer to the following link for the evidentiary requirements and listing of adult impairments SSA uses in the determination of awarding benefits: http://www.ssa.gov/disability/professionals/bluebook/index.htm. Your disability must meet the criteria of SSA's guidelines and have the medical documentation to support your claim. Often patients are denied disability benefits the first time they apply and an appeal is necessary. Having a letter from your physician, stating that you will be unable to work for a period of 12 months or longer, is crucial. You may want to check in your local yellow pages for social security attorneys. They do not collect payment until the client is awarded disability. You can also go to www.patientadvocate.org and click on the resources tab to view our publication Your Guide To The Disability Process. This book will guide you through the entire disability process.
How can I get my Social Security Disability application expedited?
Social Security Disability can only be expedited if your life expectancy is six months or less. Contact your Social Security caseworker to be sure that your case has been flagged as a TERI case, so that your eligibility can be determined at an expedited rate. You will still have to wait five months before receiving your first payment.
I have not heard anything from Social Security regarding my case for SSI/SSDI, can I check the status?
Yes. Each state has a status line listed with the Disability determination office that will allow you to check the status of your case.
Why was my Medicaid taken away when I became SSDI eligible?
When you receive your first SSDI payment, you may be over the Medicaid income limits to continue to qualify for straight Medicaid. Check with your Medicaid caseworker to determine if your state offers a cost share or spend down program which may allow you to continue your Medicaid benefits.
How can I get Medicaid?
Contact your local human services office for a Medicaid application. Your state may require that you be deemed disabled before becoming eligible for Medicaid. Be prepared to provide documentation, such as proof of income, medical records, proof of address, etc. For more information, visit www.cms.gov.
How can PAF help with medical expenses?
PAF cannot provide direct financial assistance with your medical bills. If you need assistance with negotiating with a provider, you may want to contact us for case management assistance. You can also visit www.copays.org for more information on the financial assistance for pharmaceutical therapies that are available to eligible patients.
I have an HMO and want to go out of network. What are my rights?
HMO's negotiate to include a wide variety of cost effective medical providers in their treatment network. You will need to refer to your insurance policy to determine what benefits are available for out-of-network care. Patients have the option to make a personal choice regarding the care they receive, however your insurer is not liable to reimburse your expenses if the care received is outside of its contractual obligations.
How should I appeal a denial by my insurance company?
You may benefit from our publication "Your Guide to the Appeals Process." This publication is available to download on our website www.patientadvocate.org. It contains practical information about filing an appeal and includes sample letters you may find helpful. You need to know the reason for the denial to be able to base your appeal on proving why it should be paid. It is very beneficial to include any peer review or medical journal articles supporting this treatment as being the most effective.
How do I get co-pay assistance for my medications, radiation, chemo, and medical supplies?
There are organizations that offer financial assistance for co-payments. Visit www.copays.org for information on Patient Advocate Foundation's Co-Pay Relief Program. Most co-pay assistance programs are diagnosis based. Call and speak with one of our case managers to find out which organization may best assist you.
If I change jobs will I lose my ability to elect new health care coverage?
Some employer health plans do not cover pre-existing medical conditions. HIPAA limits the time period of these restrictions so that most plans must cover a person's pre-existing condition after 12 months. Under HIPAA, your new employer's plan will be required to give you credit for the length of time that you had continuous health coverage that will reduce the 12-month exclusion period. If, at the time you change jobs, you already have had 12 months of continuous health coverage (without a break in coverage of 63 days or more) you will not have to start over with a new 12-month exclusion for any pre-existing conditions. Be sure to elect COBRA to avoid any breaks in coverage. For more information visit www.dol.gov.
I feel as though I am being discriminated at work because of my illness. What should I do?
You may want to log on to our website www.patientadvocate,org to view or download our publication "First My Illness, Now Job Discrimination". This publication will advise you of steps you can take toward resolution of your issue. Keep in mind what you would like your outcome to be. Your first step should be to file a complaint with your local office of the EEOC. Go to website: www.eeoc.gov for more information and contact numbers for your local EEOC office.
Once your claim with the EEOC is filed, they will provide you with a "right to sue" document that will specify the length of time you have to obtain legal counsel and file suit. You also need to be aware of the specific laws that exist in your state in regards to job discrimination. You may also consider contacting your State Attorney General for legal information.
I need to take time off of work due to my illness. Is my job protected?
You may want to view the laws that apply to your situation on www.dol.gov. Select "A-Z Index" and choose "FMLA." The section under frequently asked questions will answer a number of your inquiries. If you work for a company that has at least 50 employees and you have been there for at least 12 months, you are entitled to 12 weeks of unpaid leave under FMLA (Family Medical Leave Act). Under FMLA, an employee that has been with their employer at least 12 months prior to their leave of absence is protected under the law from losing their job if they need to take time from work for the reasons specified under the law (only if they work for a company with 50 or more employees). Employees are eligible for 12 weeks of unpaid leave per year. This time can be used in increments that total 12 weeks in a 12 month period. Once this time is exhausted, the employer can fill your job with another applicant. You would then have to reapply for the position. This also means your medical benefits can be terminated making you eligible for COBRA. You can also research COBRA in the same website.
I am uninsured and cannot afford my medication. Is there any assistance available?
You should apply for medication assistance through the manufacturer. To locate manufacturer patient assistance programs you may want to visit www.needymeds.com to research by generic or brand name the medications you need financial assistance with. This website has a very comprehensive listing of available financial assistance programs direct from pharmaceutical manufacturers who offer their products to needy, uninsured and low income patients.
I've just been diagnosed with cancer, I'm uninsured, what do I do now?
You should immediately apply for Medicaid at your local Department of Social Services. If you are uninsured, you will need to seek treatment and/or testing at a facility that offers charity care. Contact your local hospitals and ask to speak with a social worker or financial counselor to find out if they have any charity care/financial hardship programs. You can also locate a community health clinic for free or sliding fee services. Your other option would be to make payment arrangements with a physician willing to see you on that basis. For medical bills already incurred, you will need to find out if that facility/provider has a financial assistance program.
How can I get brochures from PAF?
We are able to send you up to 25 brochures at no cost. We have attached an order form for your convenience if you would like to order additional brochures. They are also available to download on our website at www.patientadvocate.org. You can also visit www.patientadvocate.org to view and download our publications. You will find them in the resources section of our site. If you would like to order publications, please send your request to firstname.lastname@example.org.
Can I participate in a clinical trial?
Many patients choose to participate in clinical trials in order to receive the most advanced and newest treatments. The National Institutes of Health (NIH) offer many treatment choices. Since NIH is operated by the US Government and is supported by taxpayer dollars, all care offered at this facility is free of charge. To inquire about recruiting clinical trials, please call 800-411-1222. Many programs arrange for transportation for the patient between their home and the NIH campus in Bethesda, MD.
How can I relate my concerns to my local congressman?
Visit www.congress.com . On the home page, choose "US House of Representatives" and enter your zip code + four.
Can you help me find a doctor?
We are not able to assist with direct coordination of care issues. To assist you in your search for a new physician, PAF would suggest visiting http://www.ama-assn.org/. This website will allow you to search for a physician in your area according to specialty, as well as viewing their credentials. You may also want to ask friends or relatives for suggestions or attend a support group meeting.
How can I get involved with patient advocacy?
Go to www.patientadvocate.org and click on 'get involved' and then fill out the enrollment form. You can also get there directly by clicking on the link http://www.npaf.org/participation.php?p=7 . Volunteers are always needed in all states and we appreciate your concern.
Can my doctor refuse to provide me with my medical records?
Your medical records are legally the property of the medical practice or
doctor that possesses them. Legally and ethically, they can charge a fee to
copy your record due to the staff time, equipment usage and supplies needed
to honor your request. If you are unable to afford the fees, you need to have a conversation with either your doctor or office manager to request a mutually agreeable alternative arrangement.
Do you provide medical advice?
Providing medical advice is not within the scope of our services. Speaking with your physician would be the best way to obtain answers regarding your health condition and/or symptoms. If necessary, you may want to seek a second opinion.
I am not a US citizen. What can I do to get treatment in the US?
The availability of financial support for non US residents is extremely limited. Most non-resident patients arrive with funding from their families, their own savings, or sponsorship from a philanthropic organization. Some patients do find the care they need through clinical trials. The patient, the family or the physician can inquire about currently recruiting trials and their locations. Try the following web sites: www.nih.gov National Institutes of Health-highly rated care, www.nci.nih.gov National Cancer Institute-also high rated, www.clinicaltrials.gov Additional information to make an informed decision.
How can I apply for a PAF scholarship?
For information regarding scholarships, please log on to our website www.patientadvocate.org. Click on the link 'Scholarship Information' on the home page under Resources at PAF. The information necessary to apply for the Patient Advocate Foundation Scholarship program is listed. Please use the application available on the website and submit with the required information by the deadline stated.