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Kenneth Brecko

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1 reviews

Review for Patient Advocate Foundation, Inc., Hampton, VA, USA

Rating: 5 stars  

My wife was diagnosed with gastrointestinal stromal tumor (a rare form of sarcoma) in September of 2009. We belonged to an employer sponsored health maintenance organization (HMO) which has very strict rules about going out of network. It became evident that the expertise available within the HMO was insufficient to treat my wife's type of cancer. Only a handful of experts in treating this type of cancer were available, all requiring travel to get to. In July of 2010 my wife and I attended a support group function and Patient Advocate Foundation had a couselor and display at the meeting. It was here that I met Laurel, a counselor with the Patient Advocate Foundation. Laurel took me under her wing and provided every assistance I would need to fight the HMO for a referral outside of the HMO network.

When I made the initial request on behalf of my wife for a referral, the request was denied. We had to go through the entire appeals process and were denied each time, which I am told, happens with some frequency. In my state, after the appeals process with the insurance company is exhausted, there can be an appeal for an external review. When I requested the external review, the HMO capitulated and granted the referral to the ouside expert.

Laurel was behind me 100% and provided letters and backing to whether the appeals process with the HMO. Without the assistance and encouragement of the Patient Advocate Foundation, and specifically our wonderful counselor, Laurel, we may have never been granted the referral.

I know that the Patient Advocate Foundation helps out in many areas to support and advocate for paients as they struggle for treatment, payment assistance and approvals. Having been through this, I can tell you that it is very important to have someone help you advocate just to get noticed in the medical/insurance system.

I highly recommend Patient Advocate Foundation. My wife and I had a successful outcome with their assistance. I believe they will go to great lengths to provide any assistance they can and is within their means to provide.

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Role:  Client Served