Lorie Gardner would not accept one doctor’s hesitancy to perform a life-saving procedure on her 92-year-old client.
“So, I did the research and found a top doctor who would,” Gardner said. “My client had three options, all of which this doctor explained in every detail.
“My job was simply to take notes and be an extra pair of ears and eyes as the healing went on between the patient and her doctor. Then, after the workup, I handed the doctor a prepared document with all of her medical history and list of medications.
“He was completely appreciative — and so was her family.”
For Gardner and the all-female team at Healthlink Advocates in Chatham, these sorts of patient issues are all too common.
“The health care system is not very transparent,” Gardner, founder and CEO, said. “There is a lot of reliance of the patient on a system that does not always have their interests in mind.
“So, I call myself a point guard, or a quarterback, for those who like sports — we will help anyone navigate the health care system, but we also would rather prevent them from getting there in the first place.”
Healthlink Advocates is a health care advocacy firm dedicated to empowering and educating clients on all aspects of their health while helping to reduce cost and stress and improve outcomes of health care decisions.
Not only has the firm doubled its growth each year by saving many of its clients tens of thousands of dollars or more in medical debt, but it also has provided voices for those already in confusing and nerve-wracking situations.
“We need to show people that this is an available service,” Gardner said.
It is a goal Gardner always had been working toward.
Gardner had been working as a registered nurse since 1979 before becoming the clinical operations manager for Pfizer Pharmaceutical Co., clinical study manager for Stryker Orthopaedics and a parish nurse for Saint Patrick’s Parish in Chatham.
So, when her husband began experiencing symptoms of an unusual and undiagnosed disorder, Gardner acted as his advocate.
“Doctors told me I was crazy not to treat him with certain drugs or surgeries, but I said, you have not yet proven to me his diagnosis,” Gardner said.
Shortly after, she said, Gardner herself underwent major surgery and realized just how it felt to be faced with multiple health care decisions while lying in a hospital bed.
Without an advocate, she added, diagnostic errors, duplicate tests, unclear treatment options and excessive costs were much more likely for vulnerable patients.
“I needed to go back to directly being able to help people,” Gardner said.
Gardner therefore completed a yearlong credentialing course for health care advocacy, and founded Healthlink Advocates in 2010.
Lucille Plantemoli joined her in 2011 as vice president after also working as a registered nurse, co-director of infection control for the then-Saint Barnabas Health Care system (now RWJBarnabas Health), an independent infection prevention consultant and a fellow parish nurse for Saint Patrick’s Parish.
“We were coaching and assisting parishioners and their families with their illnesses and injuries,” Plantemoli said. “I also helped my father manage his heart disease while my mother required dialysis.”
Doris Zito then joined the team in 2012 as an insurance advocate after more than 25 years’ experience working in contract management and medical services for the Department of Defense and creating her own business, Medical Claims Management, following the navigation of medical bills for her friends and family with cancer.
“My own father-in-law, who was suffering from cancer, was paying premiums each month for three different plans,” Zito said. “People were confused about where to send their bills or would not send their bills at all because they simply figured, whatever insurance did not pick up, they should pay.”
Kathy Marshall, health care and insurance advocate, and Laura O’Reilly, nurse advocate, currently complete the team of professionals and consultants at Healthlink Advocates.
“Our collective life experience as women has been essential,” Gardner said. “When we are collegial and collaborative with every person we meet, we get so much more accomplished.”
And there is always a lot to get done.
Healthlink Advocates’ ultimate goal is to provide mental and physical support for its clients.
It does so, Gardner said, by first researching and providing education on various medical conditions while identifying all possible treatment options, including clinical trials, and providing assistance on the selection of physicians and hospitals.
Advocates can then attend physician and hospital visits to liaise with the medical team, or can provide clients with a list of questions and concerns to discuss.
“As professional licensed nurses, doctors know exactly who they are talking with,” Gardner said. “We also have no allegiances to insurance companies or to specific doctors. In fact, we do not ever recommend just one doctor to our clients.”
Then, Healthlink Advocates can assist clients in navigating the complex and all-too-often fragmented health care system, including the organization of medical records, insurance billing and the management of out-of-pocket expenses.
“When conducting appeals, having a team of nurses to look over medical records and insurance bills is a game-changer,” Zito said. “They are not only used to dealing with patients as to what is appropriate treatment and what isn’t, but also understand what specific costs mean on medical records.
“For example, we worked with a middle-aged couple with children who were financially challenged by the wife’s insurance claims. She was charged $600 for a colonoscopy last summer due to a medical issue. While the surgeon had billed it as routine, the anesthesiologist had coded it according to her medical issue, and, because of that, the bill was not honored by her health insurance and she was forced to pay out of pocket.
“I discovered that, through her health care company, she was entitled to a yearly colonoscopy regardless of the reason. So, I called her surgeon to correct the problem with the anesthesiologist in order to make sure she was fully covered for the procedure.”
The team has been able to save clients nationwide up to hundreds of thousands of dollars in this way.
However, Zito said, they are not in the business of bartering.
“We were recently approached by a company in New York who wanted us to call physicians and dog them down on their cost of services,” Zito said. “That is not what we do.
“We figure out where the mistakes are and where our patients can save money, but we are not looking to tell doctors that they are charging too much for tests or procedures.”
Gardner said Healthlink Advocates’ hourly rate of $200 — and its flat rate of $400 for a complete intake that ultimately results in a detailed care plan — can sometimes result in the same sticker shock she would like to help her patients and their families avoid.
“So, at the end of each intake, we say, ‘This is your money; we honor it. Let’s work together. Are there, for example, family members that we can pull in to help?’
“We come up with to-do list so that, perhaps, one’s daughter or son can help take care of less-burdensome tasks. We then recommend the tasks that we believe we should be hired for, such as calling insurance companies as an educated and experienced third-party advocate.”
Gardner said she often works with clients on a simple advisory basis after the initial intake.
“If the patient says, ‘OK, my family and I can handle all of this, but can we call you when necessary?’ We say yes,” she said. “We don’t like to see one person left behind when it comes to their health.”
In fact, Healthlink Advocates’ ideal is to reduce medical costs overall.
Gardner and Plantemoli, both of whom are board certified health and wellness coaches, decided to ramp up the company’s focus on holistic wellness last year after having solely focused on health care advocacy.
“So many medical issues, such as diabetes and heart disease, are related to lifestyle choices and can be prevented,” Gardner said. “But changing behavior is not easy. We learned as nurses to point our fingers and tell our patients to do this or to stop doing this. (But) that does not work.”
Healthlink Advocates also offers private or group coaching focusing on 12 holistic areas, including breathing, thinking, playing, working, communicating, self-understanding, relationships, finding meaning and mindfulness.
“Wellness is more than simply diet, weight and exercise,” Gardner said. “A lot of times, the deeper, underlying issues are found on the levels of how one communicates and thinks.
“That is where we find people are really challenged.”
An initial wellness assessment and 30 minutes of professional coaching, for example, costs $129, but customized coaching sessions typically require a minimum three-month commitment.
The coaching often is done in tandem with treatments for ongoing issues such as substance abuse or chronic disease.
“Young people, especially, don’t know what it is they need to do before visiting a doctor,” Gardner said. “We coach them before and during their appointments, because they may not always get what they want or fully understand what is happening.”
While Healthlink Advocates has worked with foundations such as the New Jersey Traumatic Brain Injury Fund and the American Heart Association on presenting and embodying the newest medical guidelines, Gardner said it is the company’s goal this year to work directly with at least two small or midsized businesses in New Jersey.
“I often am concerned that human resources departments are not only overwhelmed with insurance claims, but also may be overstepping,” Gardner said. “Employees might feel better about working with independent, third-party consultants in this space. And, if a company wants to help create a culture of well-being, there may be ways to offer, for example, a certain number of hours of private advocacy and coaching to full-time employees.”
That potentially could decrease costs for companies while improving employee productivity and reliability, Plantemoli said.
“We can educate and work with employers and their employees to help navigate insurance and promote better behaviors for well-being,” she said.
While Gardner said it is her goal to hire more advocates, she said Healthlink Advocates still has room to grow within the existing organization.
“We currently work between 20 and 30 complex cases each year and are looking to again double our growth,” she said. “Some days, we go with patients to hospital visits, and others, we may be conducting research at our computers or calling insurance companies. It always varies.”
Gardner is motivated, she said, by the fact that every day — and every patient — is different.
“It is not so much a job as it is my mission,” she said.
Help me help you
Lucille Plantemoli, vice president of Healthlink Advocates in Chatham, said health care professionals are one of the most likely demographics to neglect their own care in order to take care of others.
“They work in high-stress, demanding jobs and are always working on the floor with less staff and more patients,” she said. “So, we actually have a specific wellness model to help them reduce stress and enhance balance.”
Healthlink Advocates has worked with clients such as Morristown Memorial Hospital to help implement wellness programs for their staff.
Plus, the team at Healthlink Advocates also follows their own advice.
“We try to walk the walk and talk the talk of what we do,” Plantemoli said. “We work out, we eat well — we make sure we all are living healthy, balanced lives complete with stress management and mindfulness opportunities.”
Reach Lorie Gardner of Healthlink Advocates at: Lorie@healthlinkadvocates.com or 973-908-6570.