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Medrock offers fee-for-service help with insurance disputes

Your father is ill, needs an operation, and you live 1,000 miles away. You pick up the telephone and ask to speak to your father's doctor, but he's busy and doesn't return your call. After several more calls, you discover your father's health insurer is refusing to pay for his operation. Where do you go from here?

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Investors are betting you'll want to call Medrock, the medical crisis assistance company based in Boulder, Colorado.

The sickest patients have the hardest time getting the right medical treatment.

Medrock is the brainchild of Dr. Charles Scoggin, a nationally recognized pulmonary critical care specialist; Karen Donelan, former faculty member of the Harvard School of Public Health and expert on patients' access to health care and health insurance; and Edwin M. Kania Jr., a health care investor.

They say they created Medrock, because they know how to navigate the health care system quickly and efficiently in times of crisis and they want to help others do the same. Donelan says when she was studying the uninsured, she kept coming to the same conclusion: The sickest patients have the hardest time getting the right medical treatment. "And it's just not the way it's supposed to be," Donelan says.

Be your own patient advocate

�  Claim denials: Sometimes following the rules is not enough

�  How to make claims under a self-insured health plan.

Medrock aims to change all that. For a fee, Medrock helps you find a specialist for a second opinion from its database of 70,000 physicians. It can also assist you in gathering and organizing medical records that are crucial for expert assistance and consultation. The company can even provide you with questions and answers to help you understand your loved one's medical condition — or your own.

Fee-for-service vs. do-it-yourself advocacy

Most of the services Medrock offers are obtainable on your own for free. The problem many face is finding the time to do the work. Donelan says these resources are stretched thin in our aging society, where frail husbands and wives are unable to assume the role of caregivers to their spouses and other family members live far from the patient. "People are looking for lifelines," Donelan says. "Being married to an oncologist, I see it all the time. A friend from church calls looking for help and advice, but you feel awkward going through your friend's private medical records."

"Can the failure of HMOs to serve us be corrected by more market mechanisms?"

Non-profit patient advocates are worried a proliferation of fee-for-service medical crisis and health insurance advocates means only those patients with adequate financial resources will get the help that everyone should be getting for free — especially when it comes to the appeals process for health insurance claim denials

"Can the failure of HMOs to serve us be corrected by more market mechanisms?" asks author Jamie Court in his book, Making A Killing: HMOs and The Threat To Your Health. Court, the advocacy director for the non-profit Foundation for Taxpayer and Consumer Rights in Santa Monica, California, worries private solutions might result in "another proliferation of niche businesses that play on patients' fears and are just as exploitive as the HMOs."

"Court says he's very worried about for-profit HMO patient assistant services that charge an annual fee much like a pre-paid road service plan for motorists. "You shouldn't need to buy more insurance just to collect on your policy," says Court.

Donelan doesn't disagree. "The day when Medrock's services are no longer needed would be a lovely day indeed," she says.

Donelan says patients are already paying more money for their health care. "If you're going to pay more money anyway to get the services you want and need, who do you want making the decisions? Yourself or your health plan? We're taking a risk that people are willing to pay for services the current system can't or won't provide."

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