Anne McGuire, RN, CCM

President & Owner
Advocacy & Management

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Are you overwhelmed and confused about understanding and managing your health insurance coverage? "Healthcare Pathfinder can be your guide. We provide professional healthcare advice, advocacy and management services to individuals, families and employees."

Anne McGuire is an RN and Certified Case Manager with over 35 years of experience in healthcare including EMS, Surgical Intensive Care, Home Care, and Managed Care. While working as a case manager and utilization review nurse for Tufts Health Plans in Massachusetts, Anne realized there was an immense need for Healthcare Advocates to help people understand their health insurance coverage so they can receive the best care possible and get the coverage they deserve.

For 16 years, Anne was the Director of Consulting for a small Healthcare Advisory and Advocacy firm, developing an expertise and passion for helping clients find, understand, manage and maximize their health insurance benefits. She has been extremely successful at resolving claim disputes, obtaining approval for services, maximizing benefits, and improving quality of care for clients both at home and in acute care settings.

As the founder of Healthcare Pathfinder, LLC, Anne has combined her extensive professional and personal experiences to offer comprehensive advice and advocacy services to her clients. Her experience makes her uniquely qualified to help guide her clients through the complexities of the health care system, so that they can focus on caring for themselves and their loved ones. Anne develops strong client relationships with individuals, families, small businesses and employees of large companies all over the country.

Currently, Anne is a member of the Case Management Society of America, the Alliance of Professional Healthcare Advocates, the board president for At Home In Darien, and is recently retired from the board of Darien EMS- Post 53 after 18 years.  She received her BS degree with a major in nursing from Hartwick College.  Anne resides in Darien, CT with her husband and has two adult children.

Licenses/Certifications:

  • Registered Nurse

  • Life/Health insurance

  • Certified Case Manager (CCM)

Specialties:

  • Health Insurance Advising and Advocacy

  • Claims management

  • Case management

  • Appeals and Negotiations

  • Medicare

More About Healthcare Pathfinder

Healthcare Pathfinder (HCP) is a professional healthcare advisory and advocacy firm, providing services to individuals, families and employees.  Our mission is to provide customized, confidential and trustworthy services to our clients.  Our extensive experience in the healthcare industry allows us to guide our clients through the complex healthcare world and make their experiences more manageable and less stressful.

What We Do

Insurance reviews, advice and transitions:

  • Review and evaluate your current Health and Long Term Care insurance coverage.

  • Manage and help you understand your health insurance and Long Term Care insurance coverage.

  • Consult on current and future healthcare coverage (e.g. company options, moving, COBRA, retiring, Medicare eligibility, children aging off parents plan, and other transitions).

  • Work with adult children to understand and manage their parents’ health insurance and long term care needs.

  • Help with finding or transitioning healthcare coverage and services when moving to a new home/state.

  •  Find the best healthcare coverage available for your needs and manage your enrollments (We do not sell insurance).

Medical bill and claims management:

  • Manage medical bills and claims to make sure they are filed and processed properly.

  • Work with healthcare providers and insurance companies to expedite approval of services, claims processing and maximize benefits.

  • Track deductibles, out-of-pocket expenses, and annual healthcare costs.

  • Submit appeals when claims have processed incorrectly or benefits have been denied.

  • Negotiate medical bills.

  • Initiate Long Term Care claims and provide ongoing claims management and advocacy.

Case Management:

  • Case Management services for acute and ongoing health care needs**

  • Help prepare for scheduled procedures, transitions from in-patient facilities to outpatient care settings and refer to appropriate care providers.

  • Interpret and advocate for benefits.

Ongoing support (Retainer clients only):

  • Provide ongoing client services to help with any healthcare or insurance questions or issues.

  • Provide claims management, advocacy services, and an annual review of health insurance coverage.

  • Maintain updated authorizations on file with insurance companies, and available to send to providers and professional advisors, so that we can speak on your behalf and advocate for your rights.

*Life/Health Insurance Licenses      **Registered Nurse and Certified Case Manager