Personalized Support
Patient Advocacy Services
Navigating the healthcare system shouldn't be a burden. We're here to guide you every step of the way.
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What Is Patient Advocacy?
Patient advocacy is a service designed to help patients and their families navigate the complexities of the healthcare system. A patient advocate acts as a liaison between the patient, their family, and the medical team — ensuring that the patient's needs, rights, and wishes are understood and respected.
At the E.W. Darling Group, our Patient Advocacy services are led by Erik W. Darling — a Nurse with over 20 years of experience as a Nurse Case Manager. Erik brings deep clinical knowledge and genuine compassion to every client relationship.
Led by an Experienced Healthcare Professional
Erik W. Darling is an accomplished Nurse, Author, Lecturer, Patient Advocate, and Medicare Advisor. He spent over two decades working in a variety of areas of healthcare as a Nurse, and served eight years in the United States Navy as a Hospital Corpsman. His clinical background gives him a unique ability to understand the medical side of your situation while advocating fiercely for your best interests.
How We Can Help
Hospital Navigation
We help patients and families understand diagnoses, treatment options, and hospital procedures — translating complex medical language into plain terms so you can make informed decisions.
Care Coordination
We coordinate between your doctors, specialists, and care teams to ensure nothing falls through the cracks. From referrals to follow-up appointments, we keep your care on track.
Discharge Planning
Leaving the hospital can be overwhelming. We work with your care team to ensure a safe, well-planned transition — whether to home, a rehabilitation facility, or skilled nursing care.
Barrier Resolution
We identify and help resolve the barriers patients face in accessing care — including insurance denials, prior authorization issues, and gaps in coverage.
Family Support & Education
We provide guidance and education to family members so they can be effective advocates for their loved ones and feel confident navigating the healthcare system.
Long-Term Care Planning
We help patients and families plan for long-term care needs, including understanding Medicare and Medi-Cal benefits, home health options, and assisted living resources.
Does Medicare Pay for Patient Advocacy?
Medicare generally does not pay for a privately hired, independent patient advocate as a stand-alone "patient advocacy" service. However, Medicare does pay for certain care coordination, care management, transition, and navigation services when the beneficiary qualifies and when the services are provided or arranged through a Medicare-enrolled physician, practitioner, clinic, or plan. That distinction is very important.
Medicare Part B — Community Health Integration
Medicare Part B now covers several services that can overlap with what people commonly think of as patient advocacy. Community Health Integration services may include care coordination, patient self-advocacy training, health system navigation, health education, and social and emotional support when social or non-medical barriers affect the patient's care. These services are covered under Part B, usually monthly, with the Part B deductible and 20% coinsurance applying.
Medicare Part B — Principal Illness Navigation
Medicare Part B also covers Principal Illness Navigation services for beneficiaries with a serious condition expected to last at least three months and that places the person at high risk of hospitalization, nursing home placement, decline, or death. Medicare describes this as a type of care management that helps the patient understand the diagnosis and navigate the healthcare system. These services may be provided by the provider, provider staff, or trained personnel such as patient navigators or peer support specialists, but the patient must first have an initial visit with the doctor or healthcare provider.
2024 CMS Physician Fee Schedule Changes
Beginning with the 2024 Physician Fee Schedule changes, CMS created separate payment for Community Health Integration, Social Determinants of Health assessment, and Principal Illness Navigation services. CMS specifically refers to support staff such as community health workers, care navigators, and peer support specialists — but the services must be connected to medically necessary care and supervised or billed through the proper Medicare provider structure.
Key takeaway: If you or a loved one may qualify for Medicare-covered navigation or care coordination services, Erik can help you understand your options and connect you with the right resources. Call 909-530-0816 to learn more.
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Ready to Get Support?
Call us today to speak with Erik and learn how our patient advocacy services can help you or your loved one.
Call 909-530-0816