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Please send your stories to OA so that other who read them can be filled with hope and inspiration to press on against cancer. Send your stories to kdesatnik@rcmed.com or fax to 440.942.7970 marked Attention Asst. Editor. |
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| Our plan is to provide support to empower patients, empower organizations and the entire cancer community. |
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- Nancy Davenport-Ennis
- CEO & Founder
- Patient Advocate Foundation
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Patient Advocate Foundation
800-532-5274
www.patientadvocate.org
info@patientadvocate.org
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Patient Assistance Program
866-512-3861
www.copays.org
pap@patientadvocate.org
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| Patient Advocate Foundation Helps Pay the Bills |
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| By: Kelly Desatnik |
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Fighting for a Friend
When a woman undergoes a mastectomy, she loses a vital piece of herself. But, ask any breast cancer survivor and she will tell you it's better than the alternative. Cheryl Grimmel would attest to this, having been led to that door only to beat it back with the hope of a life-saving clinical trial that almost never happened.
Life and death should never be decided by financial constraints, but this is a reality of our world and one that Cheryl was forced to confront. When she was told that her $210,000 life-saving clinical trial would not be covered by insurance and she would have to come up with the payment on her own, she was faced with the cold, harsh, and certainly distinct reality that way too many Americans face on a daily basis.
Cheryl was fortunate to have a friend in Nancy Davenport-Ennis. Nancy, a two-time breast cancer survivor, raised, with her husband and Cheryl's family and friends, $210,000 to pay for Cheryl's clinical trial at Duke University Medical Center. She also worked to establish the Virginia Task Force for Insurance Reform to pass a bill that would reform insurance coverage for cancer patients. The bill provides for a health plan that gives patients the option for coverage to enter clinical trials at no additional cost added to the plan. The tenacity of the Task Force paid off with the passage of Virginia House Bill 240 in 1994.
Patient Advocate Foundation Founded
Sadly, Cheryl Grimmel lost her fight with breast cancer in December 1994. Inspired by Cheryl's bravery and concerned that patients like Cheryl were faced with such debt, Nancy and her husband Jack worked together to found Patient Advocate Foundation (PAF). PAF 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, physicians and attorneys.
PAF, based in Newport News, VA, has a full-time staff of 44 with offices in Newport, RI; Far Rockaway, NY; Des Moines, IA; Miami, FL, and Los Angeles, CA. In addition, PAF has 162 healthcare attorneys that selflessly donate their services, mediate and arbitrate on behalf of patients. However, only less than 2% of total cases ever involve an attorney. Most cases are resolved by Case Managers on staff. PAF also specializes in solving coding, billing and Medicaid issues and offers debt credit counseling. The organization handles over 41,250 cases a year with 3.4 million requests for direct information and a success rate of over 99% nationally.
Patient Assistance Program
PAF patient data reflected that many patients assisted by PAF had difficulty meeting their insurance co-payments. According to Nancy, "Several safety nets are available for impoverished Americans, but these programs are not accessible to Middle Class Americans with benefits." In response to this growing problem, PAF, through the leadership of John H. Ennis, Jr., Executive Director of the PAF Patient Assistance Program and PAF Co-Founder, established the Patient Assistance Program (PAP) on April 1, 2004. PAP offers direct financial support to families who have some health insurance and some form of prescription benefits, but are unable to keep pace with co-payments. "If you are insured, you're typically not eligible for these programs. PAP gives patients with chronic, life threatening and/or debilitating illnesses the opportunity to afford the out-of-pocket costs that their insurance companies require," says Nancy. PAP currently assists patients with breast, lung and prostate cancer, and in January, 2005, will lend support to patients diagnosed with macular degeneration.
Eligibility & Payment
The Patient Assistance Program offers free personal service to all patients through the use of call counselors. Call counselors will complete a form and will collect medical and financial information from the patient. Once the form is completed, it is sent to the patient and patient's physician for authorization. According to Nancy, "This process is extremely fast. It usually takes between 5 to 7 business days to obtain approval. However, we've been known to move the process along even quicker. Our record time is four hours!"
Once authorization for payment has been received, the payments go directly to the provider or pharmacy. The only exception is if the patient has a pharmacy or medical provider who won't accept third party payments. PAP does require billing records and a copy of insurance language.
Support
The Patient Advocate Foundation is broadly supported by a diverse group of organizations. They recently received two grants from the Centers for Disease Control and were the recipient of an appropriation in the recent Federal budget. Other support comes from their Annual Fundraiser, "A Promise of Hope Affair." This fundraiser is warmly received by the local community in Newport News, VA.
Community Involvement
The Patient Advocate Foundation has a "Scholarship for Survivors" for cancer survivors who wish to go to college. The organization gives 10 scholarships per year to young adults whose lives have been affected by cancer. Both PAP and PAF also have booths at the ASCO Annual Meeting.
Future Plans
Mrs. Davenport-Ennis recently received a four-year appointment to the Directors Consumer Liaison Group (DCLG). DCLG advises and makes recommendations to the Director of the National Cancer Institute from the consumer advocate perspective on a wide variety of issues, programs, and research priorities. Future plans for the Patient Advocate Foundation include work with regulators to improve a system of healthcare delivery that provides equal access to healthcare in the US.
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