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Patient Advocate Foundation
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Home > Press Room > Interviews & Features > 1999 M C & C Interview > Page 2

Managed Care & Cancer Interview (continued)

MC&C: Who comprises your personnel network, and what duties do they perform?

Ms. Davenport-Ennis: Our personnel network consists of healthcare attorneys, oncology nurse case managers, social workers, case workers, and former insurance industry case managers. Initially, our National Legal Resource Network consisted of 29 attorneys; today, we have a total of 154 attorneys. For attorneys to become members in our network, they must practice exclusively in the field of health care and undergo our application process. Because we are sensitive to an applicant's history in health-care law, we look at his rating within the Martindale Hubbell Rating Service for attorneys. For every ten inquiries we receive, we accept perhaps one attorney into the network.

Some attorneys in our network have been referred to us by Sheldon Weinhaus, Esq., of Weinhaus and Dobson, St. Louis, Missouri. Chairman of our National Legal Resource Network, Mr. Weinhaus served on President Clinton's commission that drafted the Patient's Bill of Rights and has had much success in representing patients who are in ERISA (Employee Retirement Income Security Act) plans by employing the Americans with Disabilities Act as the basis for his suits; this past summer, he won his second Supreme Court case in appeal using that defense. A lot of our cases are ERISA cases, so an attorney specializing in ERISA cases need not reside in the same state as the patient being represented.

Certainly, our case managers carry a huge portion of our workload. The National Managed Care Network is our network of case mangers. We have case managers in our national office as well as others in Memphis, Tennessee, and Mason, Ohio. All of our case managers are required to have experience in one of three arenas: a hospital setting, a clinic or outpatient setting, or an insurance case manager setting. Case managers with experience in an insurance setting are an important part of our staff because they understand the approach taken by an insurer when evaluating a case for approval or denial, and we have found that to be very beneficial here.

Case managers actually handle incoming calls from patients. They either offer specific directions to the patients on how to resolve their own cases, or simply intervene directly with the hospital (in the case of a preauthorization situation), with representatives of the health plan, or with the employer to resolve the complaint. We have found that more and more of our cases are complex, involving more than one insurer and often a case manager must be involved 7 to 10 business days on a single case.

Additionally, we have a national network of patient advocates. Some of these advocates are survivors of cancer we have helped in the past and some are their family and friends. Others are simply volunteers who want to help us help patients. These people do not handle patient cases. They participate through NPAF in educational activities directed at policy issues.

MC&C: How do patients find out about your services?

Ms. Davenport-Ennis: We get a tremendous volume of patients from virtually every voluntary health agency in the United States, the American Cancer Society National Call Center, all of the major research hospitals in the country, private clinics and hospitals, our website, word of mouth, and our newsletter.

In addition, various publications have introduced Americans to us and the services we provide, and that has been a real blessing. For instance, oncology journals such as this one have embraced us with support. This past spring, Redbook magazine featured us in its list of support groups, and our phones rang off the hook. We really do appreciate the support. Although it is a tragedy that we have to be here at all, it is important to us to get help to the patients who really need it.

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