Jill Foucre, vice president for customer service for HealthNet, says the HMO works closely with the hot line's staff. Any opportunity for our members to open avenues of communication and better understand their benefits is a positive thing. Foucre says the plan tries to learn why from the hot line staff, then addresses those communications and accessibility issues internally. Melinda Eppler, communications director for Sierra Health Foundation in Sacramento, says that the ombudsman service can be a valuable extension of the health plan's own customer service department. We funded the hot line for the benefit of health care consumers who truly need a vehicle to work through their problems with health care.
Health plans can be very convoluted systems.
Wait and see Advocacy programs are in various stages of creation or legislation in perhaps a dozen states, according to Lee. N.Y. It claims to be the only health advocacy graduate program in the nation, teaching graduate students how to help patients navigate an increasingly complex health care environment. Graduates work in managed care organizations, hospitals, industry, labor unions, community organizations, public interest groups, schools and government agencies. The director of Sarah Lawrence College's Health Advocacy Program, Marsha Hurst, Ph.D., says that the real client for any health plan is the employer. If there are too many complaints from employees, the employer will be forced to look for another plan next year.