I am current working with a young woman/Mother who is a intractable chronic pain pt and her pain doc without any discussion reduced her opioid OF TEN YEARS from 15 mg QID to 5 mg BID and put a her on a Buprenorphine Transdermal Patch which threw her into a SEVERE COLD TURKEY WITHDRAWAL!
Her blood pressure the next day was 240/120. I suggested that she take the patch off and BP dropped a little but still in the hypertensive crisis level. Tonight it is 230/103 and per pain level is 8+.
She is on traditional Medicare. I went looking to see what pt advocacy Medicare Part B has and this is what I found out. I also looked at what may be available for Medicare-C (Advantage)
Should pts start putting their insurance company or some advocates “feet to the fire”. After all, the insurance companies are being paid monthly premiums – by someone – and supposedly most of these insurance companies claim that they have a large number of contracted practitioners to take care of the pts that are policy holders.
The FDA released this statement LAST WEEK: The FDA is now requiring that opioid labels emphasize the importance of avoiding rapid dose reduction or abrupt discontinuation in patients who may be physically dependent on opioid pain medicines, as it can cause serious harm.
Maybe pts should tell their insurance company that if they can’t help you find a practitioner that will help manage their pain. They will go to the ED EVERY DAY and ask to be admitted.
Maybe if they “blow you off “, perhaps talking to a reporter about how you insurance company wants your monthly premiums but doesn’t have any contracted practitioner that will address/treat your health issues.
Traditional Medicare Part B does not directly provide or cover the cost of hiring a professional patient advocate, but beneficiaries have access to advocacy resources and support services through federally funded programs and organizations.patientadvocatesofswfl+2
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Medicare Beneficiary Ombudsman: Medicare maintains an Ombudsman office that resolves beneficiaries’ issues and provides guidance on rights and protections. You can access this help by contacting Medicare directly at 1-800-MEDICARE.medicare+1
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State Health Insurance Assistance Program (SHIP): SHIP offers free, unbiased Medicare counseling and advocacy about benefits, enrollment, coverage problems, and appeals. These services are available in every state, including Indiana, and can be reached at 877-839-2675.medicalnewstoday+2
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Nonprofit Organizations: Groups like the Patient Advocate Foundation and the Center for Medicare Advocacy offer personalized assistance for Medicare eligibility, coverage issues, appeals, and understanding benefits, often free of charge.patientadvocate+3
Although traditional Medicare Part B lacks a dedicated, covered patient advocate service, these agencies and programs offer substantive help for beneficiaries navigating coverage and resolving problems. However, hiring a private patient advocate would require out-of-pocket payment, as this is not a covered service under Original Medicare. If you need personalized advocacy, consider contacting SHIP or nonprofit organizations for guidance and support.retireguide+1
Medicare Advantage (Part C) plans—unlike traditional Medicare—are offered by private insurers and must follow Medicare rules, but each plan may include different additional benefits and supports beyond standard coverage. Here’s how patient advocacy works with Medicare Advantage:
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Medicare Advantage Plan Supports: Many Medicare Advantage plans now cover patient advocacy services, such as care coordination and help navigating claims or appeals. This coverage has expanded especially since 2024, making patient advocates—such as those from organizations like Solace—accessible to beneficiaries at little or no out-of-pocket cost. The specific benefits and coverage may vary by plan and region, so it’s important to check your plan details or ask your insurer directly.solace+1
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Case Management & Grievance Processes: All Medicare Advantage plans are required to have clear processes for handling patient grievances, appeals, and complex care coordination. If you have a complaint, need to appeal a service denial, or require help with care planning, your plan’s customer service or case manager is your first point of contact. These supports are mandated and may feel similar to an advocacy role, but the individual still works for your insurer, not independently for you.in+1
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Independent and Nonprofit Advocacy Resources: Like with traditional Medicare, you can turn to independent nonprofits—such as the Patient Advocate Foundation and the Center for Medicare Advocacy—for personalized guidance, advocacy for appeals, and education about your rights. These organizations assist all Medicare beneficiaries, including those in Medicare Advantage plans.patientadvocate+3
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State Health Insurance Assistance Program (SHIP): SHIP counselors provide free, unbiased help to Medicare Advantage beneficiaries, including help with plan benefits, grievances, and appeals. This service remains available regardless of which plan you have.cms
Summary Table: Patient Advocacy with Medicare Advantage
| Resource | Type of Support | Cost |
|---|---|---|
| Plan Case Manager | Claims, appeals, care coordination | Included in plan |
| Nonprofit Advocacy (PAF, CMA) | Personal assistance, education, appeals guidance | Usually free |
| Solace Advocates (2024+) | Hands-on advocacy, care coordination (select plans) | Often free/covered |
| SHIP | Unbiased counseling for all Medicare options | Free |
| Hospital/facility advocates | Bill and care issues during hospital stays | Included |
Medicare Advantage brings additional advocacy options, especially since 2024, but the availability and cost depend on your plan and local resources. For more personalized advocacy, reach out to your plan, SHIP, or independent groups for support with billing, appeals, or understanding your benefits.patientadvocate+2
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