Questions.
The ones people ask on the first call, and a few they ask later.
Questions people ask on the first call
How is this different from the patient advocate at my hospital?
Hospital advocates work for the hospital; insurer case managers work for the insurer. Your Simbioza advocate works for you, follows you across every doctor and plan, and answers to no one else. We don't provide legal representation.
Do you actually handle referrals, prior authorizations, and denials?
Yes. We book the referral and chase the earlier slot, file the prior authorization and follow it to a decision, and write the appeal in the language a reviewer needs.
Is this covered by insurance or Medicare?
It may be. Medicare and some plans cover patient advocacy and navigation for eligible patients, and if you qualify we'll tell you on the first call so you can choose. Reimbursed: little or no out-of-pocket beyond a copay, but eligibility is decided by the plan, time is capped by the billing code, the advocate is assigned by the plan and answers to it, and the service usually ends when your plan or doctor changes. Self-pay with Simbioza: you pay directly, but there are no eligibility rules or minute caps, you keep the same advocate across every doctor and plan, and they answer only to you. Many HSA/FSA plans reimburse either way.
Do you replace my doctors?
No. They diagnose and treat. We make sure they're working from one plan and that the work between appointments happens.
What if it isn't working?
Cancel anytime, no fee. And if your first-week call and written plan of care don't happen in 7 days, you don't pay.
What is a patient advocate, exactly?
Someone who acts on your behalf against the friction of the system: the referral that isn't happening, the denial nobody appealed, the two doctors who don't talk. Ours also coordinate your care, navigate you through the steps, and manage the whole case in one file.
Is this therapy or medical care?
Neither. We don't diagnose, treat, or prescribe. We make the system work around the doctors who do, and we coach the part between appointments.
Can a family member be on the calls?
Yes, and we encourage it. You decide who's on your case.
Which states do you work in?
16 today; the list is on our states page and in every form.
Is there a contract?
No. Week to week or month to month, cancel anytime.