Home :: Site Map :: Privacy Policy

Patient Advocate Foundation
Phone: (800) 532-5274
Fax: (757) 873-8999
Home > Press Room > Interviews & Features > 1999 M C & C Interview

Managed Care & Cancer Interviews: Nancy Davenport-Ennis

Managed Care & Cancer LogoBy Mary Lou Patterson Smith, JD
Reprinted with permission from Managed Care & Cancer (Nov/Dec 1999; 1:45-46).
Copyright 1999, PRR Inc., Melville, NY

Inspired by a young mother's struggles to obtain preapproval from her insurance company for a lifesaving bone marrow transplant for stage IV breast cancer as well as her own bouts with breast cancer, Nancy Davenport-Ennis embarked on a new career in health-care reform. She helped establish the National Patient Advocate Foundation (NPAF) and the Patient Advocate Foundation (PAF) in April 1996. The NPAF is a 527 Corporation committed to creating access for improved care and funding for patients through policy and legislative reform on both the federal and state levels. The PAF is a nonprofit direct patient services organization that provides patients with chronic, debilitating, or life-threatening diseases with the services of either a professional case manager or an attorney to resolve problems in three primary areas: insurance matters, job discrimination, and debt crisis. In this issue of Managed Care & Cancer, she offers an inside look at these two patient advocate organizations, their legislative success, educational programs, and future goals.

MC&C: What types of patient problems are handled by the National Patient Advocate Foundation and the Patient Advocate Foundation?

Ms. Davenport-Ennis: Currently, in the Patient Advocate Foundation, we focus primarily on three types of problems faced by patients with a chronic, debilitating, or life-threatening disease: insurance-related matters, job discrimination, and immediate debt crisis. First, insurance difficulties, which represent about 80% of all of our casework, can be anything from preauthorization of care to providing payment for care after it has been rendered and the insurer refuses to pay. We handle cases with every type of insurance, including CHAMPUS, Medicare, Medicaid, HMO (health maintenance organization), managed care, or indemnity plans. We also handle underinsured and uninsured patients, often integrating our services with state, national, and/or community services as well as with support provided by the Ecumenical Counsel of Churches and Catholic Charities.

Second, we focus on cases of job discrimination that result from the diagnosis of disease. Third, we offer immediate debt crisis intervention. We have become proficient at being able to negotiate with creditors for reduced payments, deferred payments, and for write-offs of balances due. Within our organizations, we have built a national resource directory of state programs available to help with debt crisis and have tried to integrate with other disease-specific nonprofit organizations that may be able to offer some financial reimbursement or support.

This year, we will have funds available to offer actual financial support to patients who call in with immediate debt crisis problems or who have been denied coverage for a certain therapy, and the cap to that support will be $1,000 per year per patient. We also plan to focus our financial support in the areas of housing, utilities, transportation to and from medical care, and food vouchers. Patients are often caught in no man's land between being unemployed because of their disease and not having completed the 90-day application in waiting process to obtain social services support; we would like to be able to lend support during this period.

MC&C: How successful have you been in resolving such problems for patients?

Ms. Davenport-Ennis: The Patient Advocate Foundation operates on a fiscal year. From July 1, 1998 through June 30, 1999, 76% of all of our cases were resolved by our case managers. Of the 24% of cases that went into our legal network for resolution, none went to court; all of them were settled, typically within a 30-day period, through negotiation between attorney and representatives of the employer or the health insurance plan involved.

Go to page: 1 | 2 | 3 | 4