When Maureen Warren’s primary care doctor told her she had blood-filled tumors on her liver – but not to be concerned – she accepted the diagnosis without question.

She’d never really been sick before. She trusted her doctor.

“I was like, ‘Oh, OK. I guess I don’t need to worry about it,’ ” she said.

Patient advocate Sandy Colter wasn’t so accepting.

Colter, a nurse with Patient Advocates, urged Warren to get a second opinion. She researched the best specialists, pulled some strings to quickly get Warren in to see a liver doctor in Boston, and then accompanied her to the appointment.

Warren didn’t think the concern, the second opinion, the abundance of caution was really necessary. Colter did.

Turned out Colter was right.

The blood-filled tumors were in danger of rupturing, a life-threatening condition.

“I don’t know what I would have done without her,” Warren said. “I wouldn’t have gone to Boston. Who knows what would have happened?”

Patient advocates – liaisons between patients and doctors or hospitals – have become more popular in recent years as people find it harder and harder to navigate the world of medicine. Advocates are still not so common in Maine, but Patient Advocates, a Central Maine business, is changing that.

Warren, a 54-year-old commercial loan associate with Northeast Bank, got an advocate as part of her job’s basic health insurance benefits.

Second opinion

Based in Gray, Patient Advocates caters to self-insured businesses, offering administrative services and employee health screenings. But patient advocacy – representing someone who’s sick or injured – is its biggest service.

“The real heart of the company is the advocacy division,” President Jim Ward said.

Ward started the business in 1995 after selling his first two health-care companies to Maine Blue Cross and Blue Shield. He’d been involved in patient advocacy before and wanted to do it again.

Although anyone can hire an advocate from Patient Advocates for about $90 an hour, most of the company’s business comes from employers who want the benefit for their workers. Patient Advocates has just under 30 clients and serves 15,000 to 20,000 of their employees. The service is paid for by employers and free to employees.

Eight full-time nurses run the advocacy program.

“We want the patient to have the care we would want for our parents, daughter, son, aunt, uncle. Any close relative. We want that patient to get the very same care,” said Marcia Bartholomew, a veteran nurse who manages the program.

Sometimes patients’ needs are basic – they want a second opinion but don’t know where to go, for example. Other times, they need the medical equivalent of a knight in shining armor.

That’s what Warren needed.

It was December 2005 when she started feeling ill. Her doctor thought she had a gallbladder problem, until an ultrasound found several large tumors in her liver.

Warren was terrified.

“Of course, the first thing they think of is cancer,” she said.

Further tests showed not cancer but hemangiomas, benign tumors involving blood vessels. Her primary care doctor told her not to worry.

Warren’s employer was self-insured and used Patient Advocates as its health plan administrator. When Warren called Patient Advocates to make sure her diagnostic tests were covered, she was connected to Colter who, among other duties, was an advocate.

“I wasn’t even aware we had that (advocacy) offered to us,” Warren said.

Worried about the size and number of the tumors, Colter urged Warren to get a second opinion. After some convincing, Warren agreed.

Colter researched doctors, giving Warren a list of specialists to consider. When time ran short – the new insurance year was about to start and Warren was concerned about paying for another deductible – Colter immediately got her in to see a liver doctor at Tufts Medical Center in Boston. Because Warren, who lives in Buckfield, didn’t want to drive in Boston, Colter arranged for her to take a bus.

And then, because Warren had little local family support, Colter offered to accompany her on the trip.

“I’d never been to Boston, didn’t know my way around. Of course I was kind of scared,” Warren said. “She volunteered to go. I met her at the bus station, first time I’d ever seen her. We talked about what we were going to talk about with the doctor once we got down there. She was absolutely great.”

‘Long-term payback’

Warren’s relationship with Colter isn’t unusual.

Advocates at Patient Advocates routinely encourage second opinions, particularly from doctors in Boston, where medical care is often cheaper than Maine and there are more specialists to choose from. They also routinely research doctors for patients, make travel arrangements and set up medical appointments, usually getting them more quickly than patients because of their persistence.

Hospitals, including St. Mary’s Regional Medical Center and Central Maine Medical Center in Lewiston, typically offer their own patient liaisons. But because independent patient advocacy is still not that common in Maine, area employees generally see Patient Advocates as a curious perk.

“I get a lot of patients who say, ‘I don’t deserve this.’ They’re like, ‘Why are you doing this for me?’ ” Colter said. “And they’re surprised, like, ‘Why do you care so much?’ “

Employers see it as a way to keep workers happy and healthy, which keep insurance costs down.

“Do we spend a little extra money by having patient advocacy? Yes we do. But we feel there’s long-term payback in it,” said David Twomey, finance officer for the Roman Catholic Diocese of Portland, which uses Patient Advocates for about 350 lay employees. “We’re self-insured and part of the reason we went into this is some terrible financial results. We had one year where we had to increase our premiums to the parishes and the employees by 40 percent. Last year we cut premiums 5 percent and this year we’re not increasing premiums.”

The American Hospital Association sees patient advocacy as an evolution in care, something that’s good for both doctors and patients – particularly patients who don’t have family to advocate for them.

“They really need someone at their side who’s going to listen to what the physicians and nurses are telling them, ask the right questions, and help them navigate the system,” association spokesman Rick Wade said. “A good patient advocate is not going to intervene in the relationship between the patient and the physician. They’re going to be a catalyst for that relationship, to ensure the patient and physician can communicate with each other, to be certain the patient understands everything the physician is saying.”

Shortly after her second opinion, Warren had a procedure to reduce the blood supply to the tumors on her liver. The tumors remain, but they haven’t ruptured and her chance of surviving if they do are greater than before the procedure.

Two years later, she’s still grateful for the advocacy.

“I don’t have much family. Sandy kind of took over and did what she needed to do to get me the help I needed,” Warren said.

She and Colter remain in contact. Warren has had some other health issues and the advocate has helped her through those, too.

What started out as a curious perk has turned into one of her favorite benefits.

“For me, I’m just thankful my employer has this for their employees,” Warren said.