A patient advocate is a person who helps a patient resolve issues about health care, medical bills, and job discrimination related to a patient’s medical condition. Patient advocates can be anyone who has an effect on the patient’s health including doctors, insurance companies, employers, case managers, nurses, social workers and lawyers. If a child is seen by a physician at one of the children’s hospitals, emergency departments or at a neighborhood clinic, a nurse or a social worker or other patient advocate can assist with a BREATH Application. By enrolling a client in BREATH, the patient advocate agrees to ensuring:
- They find a long-term medical home for their health care coverage whether it’s through Medicaid/MO HealthNet for Kids/IL All Kids or another prescription assistance program. AAFA-STL’s coverage for full-pay clients lasts for 3 months; until the $925 financial limit is reached; or until the client has been accepted into Medicaid/MO HealthNet for Kids/IL All Kids. By enrolling the applicant into BREATH, the advocate is responsible for helping them with a long-term medical home.
- The client has been formally diagnosed with asthma and/or allergies.
- The BREATH application is completely filled out. Incomplete applications will no longer be processed.
- AAFA-STL receives a copy of the patient insurance and prescription information and ID (i.e., insurance and pharmacy card(s)), if applicable
- Patients meet income eligibility criteria to the best of the advocate’s knowledge, and the advocate has informed the applicant he/she needs to submit their Proof of Household Income Examples with their application (unless currently in the hospital – they have one week from application to submit income documentation).
- Prescribing physician information (name, address, telephone number, fax number, contact name)
- You have permission from the patient or guardian to apply on their behalf. You will be required to attest that you have spoken with the patient and have received his or her permission to submit an application to AAFA-STL. You will have to provide your contact information as well as information for the applicant.
- The client is eligible to apply to the program to the best of your knowledge.
Patient Advocate Checklist
- Complete the application.
- Let the patient know to contact AAFA-STL at their earliest convenience to get further instructions on enrollment.
- Get prescriptions transferred over to Beverly Hills Pharmacy.
- Remind clients to submit income verification within a week of applying if they are in the hospital at the time of application. It is the patient’s responsibility to ensure AAFA-STL receives the required documentation within seven days of the application date.
- Ensure you are helping them find a long-term medical home for their coverage whether it’s through Medicaid/MO HealthNet for Kids/IL All Kids or another Prescription Assistance Program.
- Give patients a copy of the application with their next steps and AAFA-STL’s contact information.
After applying to BREATH, patients will receive a phone call from AAFA-STL to inform them of the status of their application and to answer any relevant questions.
If the client is not approved: AAFA-STL will provide additional asthma/allergy resources that the client may find useful. We keep a list of up-to-date resources for full-pay and copay clients on our website that clients can access at any time.
If the client is approved, the client can expect/must:
- Get their medicines filled at Beverly Hills Pharmacy (AAFA-STL works exclusively with Beverly Hills Pharmacy who delivers medicines for free to our clients).
- Get their asthma/allergy prescriptions over to Beverly Hills Pharmacy by transferring them from a different pharmacy or by having their prescribing doctor call 314-381-8600 ext. 3 or fax prescription information to BHP at 314-381-6844.
- Call BHP and tell them you are a client of AAFA-STL, you would like to fill your asthma/allergy prescriptions and would like to arrange delivery or pick up.
- To receive their welcome packet which will be mailed within two weeks of the welcome phone call.
- Complete mandatory surveys:
- Complete mandatory periodic surveys about how their child’s asthma is doing. A typical full-pay client will receive a survey with the welcome packet and again after their coverage through AAFA-STL ends. A typical co-pay client will receive a a survey with the welcome packet, again at two months & six months in their first year. After their first year, copay clients will receive a survey twice a year. AAFA-STL reserves the right to stop coverage at any time at the discretion of the staff and/or board of directors.
- Keep in touch with AAFA-STL:
- Promptly notify AAFA-STL if any information in his/her application changes at any time, including any change in the patient’s income level, financial situation, insurance or medical condition.
- Do their part:
- Full-pay clients must apply for health coverage to ensure children have adequate coverage after the BREATH program ends. Please let AAFA-STL know what Medicaid/MOHealthNet/IL All Kids determines for the client.
- Copay clients are eligible to reapply annually in May for continued assistance.