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Arvada, Colorado


New Partnership

Mandy D'Ambrosia

It is with great excitement that we announce a new partnership and joint business venture, Tribus Transitions.  Arrow Forward will continue to service clients with our focus for this business on claims and medical billing related issues.  While Tribus Transitions will focus on the case management part of our business.

This joint venture will allow for a more comprehensive and streamlined approach for healthcare transitions, when a patient is being discharged from a hospital to another healthcare setting or back to their home.  Currently these transitions, like the rest of healthcare, is fragmented as several different providers work on different parts and at different times.  This has led to disjointed transfer of information and confusion which can have dire consequences for the patient.  

It is not uncommon for a large burden to be put on the caregivers, usually family members, to try and navigate their way through the healthcare maze.  Most of the time this support team doesn't understand the complexties and is left feeling confused and frustrated.  

Tribus Transitions through it three areas. medication review, care management, and elder care consultation, combines over 80 years of experience to bring better outcomes and less stress for their clients. In these three areas it is common to have issues that lead to bad outcomes.  We provide a one stop approach to help families and patients feel that someone is there for them and can guide them through this hard time with their expertise of the industry while not having to reach out to several different companies.  

We invite you to check out the website,, to find out more about our packages and to learn more about the Founders of the company.  



New Partnership for 2016

Mandy D'Ambrosia

Denver Patient Advocate Arrow Forward Announces Partnership 

Deal with Remede gives more patients access to advocate with free consultants

DENVER — Feb. 4 — Arrow Forward, a medical advisory firm that advocates for and advises clients as they navigate the health care system during a medical diagnosis, is excited to announce its partnership with Remede LLC that will expand patient options and opportunities in health care.
Beginning Feb. 8, 2016, the partnership allows patients to have a free, 30-minute consultation with a professional private medical advisor from Arrow Forward in order to answer questions about health care-related issues, including health insurance, and provide tips about how to navigate the health care system from people who have extensive experience within it. Patients needing a longer consultation will be able to hire a personal medical advisor to work as their advocate.
"Dealing with the business of health care on top of medical issues is stressful and confusing,” says Mandy D’Ambrosia, president of Arrow Forward. “We at Arrow Forward have the expertise to take on these tasks and take away stress to allow you and your family to focus on the job of getting better and enjoying moments together. We are excited to launch this partnership with Remede that will allow us to reach more patients in need of an advisor."
The Englewood, Colorado-based Remede helps insurance brokers, Realtors, accountants, lawyers and other consultants strengthen relationships with existing clients, and gain new clients by standing out from the competition and enhancing their value.
“Partnering with Arrow Forward is particularly exciting because the demand for advocacy is so great since the changes resulting from health care reform,” says a Remede spokesperson. “Arrow Forward stands alone as a company that can effectively provide meaningful results to those in need of medical advisory services.”
Patients in need of a free, 30-minute consultation with a medical advisor, or who desire to hire one, can get more information by visiting

About Arrow Forward

Arrow Forward is a Denver-based consulting firm that helps patients and their families along the Front Range navigate through the complex and fragmented health care system when dealing with a major medical diagnosis. Services provided include assessment of the disease, treatment and resources; finding resources to help with treatment; coordinating a treatment plan; attending physician visits and providing support; and reviewing insurance plans and cost assessments. Arrow Forward was founded in 2013 by patient advocate Mandy D’Ambrosia whose varied experience in the health care industry extends back to 1998 and gives her an insider’s knowledge of health care systems that helps her guide clients through roadblocks and avoid pitfalls along their health care journey. Mandy has an MBA and master’s degree in health care administration and is certified by the Patient Navigator Training Collaborative in Patient Navigation. Learn more at

One of Many Examples

Mandy D'Ambrosia

The frequent encounters experienced in the healthcare world lend itself to opportunities where a healthcare advocate would very helpful. An example was presented a few weeks ago as I sat with a patient waiting to get an endoscopic procedure. The pre-operating area is set up so there are multiple beds that are separated by thin curtains. While you don’t see the individuals and no attention is made to the names, as you sit and wait for the many specialists to come and visit there is time to listen to the stories.

The woman in the next bed over was in for some type of procedure that involves her being sedated and then a tube is placed down her throat to investigate the cause of her issues.  The conversation starts between her and the doctor performing the procedure. He has decided that he would like to do an ultrasound during the procedure. He has done no pre-approval for this procedure and feels that her insurance is likely to deny it. This conversation is happening literally minutes before she is set to be wheeled in for this procedure. He comes back after about five minutes to confirm they did deny it and tells her she should just go to her primary care doctor and ask for them to perform a CT. Red flag!

The first issue with this interaction is the fact the doctor is making this decesion the day of the procedure. When the case was reviewed and scheduled (scheduling is done several weeks out) the doctor should have decided the ultrasound needed to be done. This could have helped to make sure all information is gathered and also give opportunities if there were denials for appeals. Instead of this happening, the doctor is now put the burden on the primary care doctor and makes the woman go through an additional invasive procedure that is costly and time consuming. 

The next red flag happens when the patient meets with the anesthesia team for them to gather information about any possible complications from pre-existing issues.  A number of questions are asked about the woman’s health. When they get to questions regarding her heart she casually brings up the heart attack she had three years prior. The doctors are concerned and begin to ask more questions regarding what treatment they did, what kind of drugs they prescribed. The woman states, “Yeah it was a smaller artery so I am not sure they did much.  I was in the hospital for a week and they did a bunch of stuff, but I can’t remember what they were called.”

This issue poses a real risk during the procedure and the fact that the team is learning about it from the patient minutes from the procedure is concerning.  The woman did not even bring up this issue with the procedure doctor and it is scary to think if no one knew on the team about this issue and were not alert for issues. So where does a patient or healthcare advocate come into play?

The advocate is there to make sure that the team is all on the same page. One of the first steps done at Arrow Forward Advocacy is getting an information baseline. Information such as a previous heart attack is discovered since this issue could lead to complications. When an advocate is able to get all of the pieces of the puzzle than information that includes previous “stuff” helps the doctors make better decisions. 

Also working with the doctors to understand what the treatment or procedures they are looking to perform can make sure any pre-authorizations happen earlier, not when you are laying on a table getting ready to be wheeled in for the procedure.

An advocate saves time for the patient and doctors in getting all those pieces put together.  We save money and efforts in helping to avoid extra procedures and can make a real difference in care and avoid complications that can be severe.    

Remembering our Heroes

Mandy D'Ambrosia

As many of us take a few moments to reflect today about those we knew that fought in war or conflict for our freedoms, may we also spend time thinking of ways to support our soldiers once they return. Whether that return from duty was yesterday or they returned decades ago it is important to remember the sacrifice. Veterans of World War II are dying by large amounts due to their age.  Veterans of the Korean and Vietnam conflicts are retired or close to it and are dealing with their own set of issues, some with big emotional or physical scars from their service.  Even after all these years we must make sure we continue to repay them for their service.

Veterans of more recent combats or wars are facing a new set of hurdles. Medicine has greatly advanced between the major conflict of Vietnam and the one we fight today in the Middle East.  Injuries that killed thousands on the battlefield previously we are able to save today. These soldiers still suffer major injuries; this is especially true for the soldiers with traumatic brain injuries. A set of injuries that can be especially challenging, many of these veterans may seem fine but the injuries continue to linger for months if not years and are complex to heal. Medicine continues to evolve in this arena as they try for new and better ways to treat.

There are a number of organizations out there to help different types of veterans. Here are just a few, many with local chapters.

Wounded Warrior Project-   

The American Legion-

Vietnam Veterans of America-

Korean War Veterans Association-

Whether you make a donation and/or volunteer, your support for these soldiers shows you don’t take their sacrifice in vain.  We must never forget.

Stress is a bad six letter word

Mandy D'Ambrosia

Whether someone is facing a diagnosis of cancer or a chronic condition like diabetes; complex medical disease create stress.  The initial stress may feel more severe, but the day to day tasks of disease weigh on the patient and those around them and are just as harmful.

A big reason for all this stress and distress is fear.  Some common fears are the fear of dying or fear of a lifestyle change.  The unknown is stressful because of the mystery of what lies ahead.  Many are scared of what this disease may cost; will it wipe away their nest egg or will they have to move to a smaller house.  On top of the mental stress is the physical sickness that causes pain and suffering; when not feeling well it is hard to listen and make good decisions.  All of this can be recipe for disaster and threaten the goal of getting and feeling better.

The bad news is stress can be making that goal even harder to achieve.  Numerous studies have been done that show stress actually lowers the body’s immune system.  This makes it harder for people to fight infections and become sick more often.  Those with chronic conditions or patients going through chemotherapy already have a lowered immune system; adding stress onto it only makes it harder.

Stress is not only lowering the immune system, it also makes health outcomes worse.  An article done in Circulation (2000;102:630-635) the authors did a five year study and found those with chronic stress had poorer health outcomes than individuals with lower levels of stress.  One scientifically proven way to lower stress is having a good support network.

However that support network needs to be careful too.   The statistics for the caregivers show stress impacts them, sometimes even harder than the patient.  An article in Cancer (1994, 73;2791-802) found caregivers health deteriorates with their stressful job of taking care of loved ones; sometimes it  becomes worse than the patient. 

Why?  The caregivers takes on a lot of responsibilities for the patient along with the stress of having someone they care about dealing with a disease.   This leads to physical and psychological stress for the caregiver or loved one. Many times they put their own needs aside due to time constraints or a feeling of needing the patient to be their top priority.  This means they are not doing the necessary things to stay well and healthy.

Our current healthcare system only adds gasoline to a bad situation.  The treatment issues are complex, the providers are fragmented or separate from each other, and insurance issues can be confusing and costly. 

The good news is there is an ally.  The patient advocate can lower stress for the patient and their family by simplifying the complex.  Issues that are taking valuable time and adding stress the advocate can shoulder and find solutions because of their insider's knowledge. 

While a good advocate should never promise there will be no stress, they can help minimize it.  Take the easy step to the best possible outcomes and get the best support team possible.  A patient advocate is an important member of that care team. 

Your Trip to the Doctor

Mandy D'Ambrosia

A trip to the doctor is something most people dread.  Most of the time when you visit the doctor you are looking for help to feel better.  Typically you have a cold or another minor issue that you may need medication for or just want to make sure it is not something more serious.

Now when the mundane turns into the serious…that is where real anxiety and stress steps in.  Receiving the news of serious disease or illness causes a physical response referred to as flight or fight.  What does that mean exactly?  Well likely you heart is racing, you feel nauseous, have tunnel vision, and start shaking while the doctor is telling you something that can change the course of your life. 

So you didn’t feel good when you came in and NOW you really don’t feel well!  In this state do you think it is likely you are will take in what the doctor is saying to you?  The answer is no.  Numerous studies have been done and the conclusion is people remember only a few things said; forgetting more than 50%!

One of my recommendations is you have someone else in the room with you.  When doctors are telling you a big diagnosis they usually request to have someone else there because what is described above is likely to occur.

It is not enough to have someone there; they should bring two things…paper and a pencil/pen.  You must write down what the doctor is telling you.  Even the person sitting there is not likely to remember most of what is said, especially if they are a family member that is invested in your health, so notes must be taken.

Having someone there taking notes can go a long way in making sure the facts are recorded and can be reviewed later.  So where does a patient advocate come into play?

A patient advocate can offer several different ways of helping…

1.        When you have a patient that does not have a local support system or the support can’t take time off of work to go to appointments.   This is especially important if the person is suffering from Dementia or Alzheimer’s and does not have the capacity to understand what is being discussed.

2.       Patient Advocates are not emotionally involved with the patient and are more objective during the visit.  No likes to see people sick, but unlike a family member or close friend patient advocates don’t have the emotional attachment to the person.  This allows your advocate to record all of the facts and listen with both ears; meaning not listening and trying to emotionally process what is being said at the same time. 

3.       The knowledge that a patient advocate brings to the situation most people don’t possess.  The health care system is complex and fragmented.  There are questions and insider’s knowledge most people don’t even know to bring up; things that are missed that can impact treatment costing money and pain and suffering.  When you have a patient advocate to guide you through the doctors’ visits than you have that knowledge on your side.

We all understand why big diseases are so hard for people; it is an emotional time that can be very overwhelming.  This is why it is so vital to have the best team possible on your side to help you get better.  Having a strong support system makes a huge impact with your treatment.  This includes your family and friends; it also includes an expert who understands the challenges you are facing…the patient advocate.

Welcome and Let Me Help You

Mandy D'Ambrosia

My passion for helping people navigate the complex and disconnected healthcare system is the driving force behind starting Arrow Forward Advocacy.  My personal and professional experience has shown me far too often the tragedies and delays that happen when you are unsure.  You may not even have the experience to know pieces that are important until it is too late.

Many people are unfamiliar with how the system works.  If your experience up to a serious diagnosis has been about seeing a doctor for a cold, a bump, or getting a physical then you are unprepared for the complex healthcare world. 

Most of the time the different parts, i.e. doctors or hospitals, are completely different companies.  They may or may not have a relationship with each other and many times if they communicate it is through a fax machine.  There is no central record for you and things get missed all the time.

So you are emotionally dealing with a very serious issue and in charge of communicating the information between all the companies, making sure you have all the right questions answered, all the right information is given, AND figuring out your insurance on top of it all.  Additionally, many times you are not feeling well which makes everything even more difficult.

So where I step in is helping you take on that burden.  I communicate with all those pieces and help you understand your insurance.  I help make sure that you are asking the right questions and serve as your advocate so you don’t miss important information.  All of the information I put into an easy to understand document that serves as your road map on your journey. 

You are in for the fight of your life.   Make sure balls aren’t dropped that could cost you money, time, pain, or something more important than all of those…your life!