The doctor is recommending tests that don't seem necessary, the hospital charged you $20 for that Tylenol you took during your stay -- and what can you do about it? Whether in the hospital or opening your bill afterward, it's easy to feel helpless against the enormous health-care industry. Luckily, there are passionate professionals whose job it is to help patients navigate the health-care jungle. If you're feeling overwhelmed or mistrustful, there may be an advocate who can help you.
What are patient and medical billing advocates?
Most health-care advocates come in one of two forms: a patient advocate or a medical billing advocate. A patient advocate is there during your hospital stay or doctor's visit to make sure medical professionals are acting in your best interest. This could be a spouse or family member who knows enough about health care to ask the right questions, or a professional who provides this service. Sometimes patient advocates are hospital staffers, and sometimes they are nurses or social workers or chaplains.
Medical billing advocates are available, after you've received care, as experts to go over your medical charges and make sure they are fair. They can help you appeal to the hospital to lower your overall costs and may also help to get more charges covered by your insurance company. In some cases, billing advocates find thousands of dollars in savings.
What services do patient and medical billing advocates provide?
A patient advocate is usually by your side to ask your doctors and other caregivers the right questions, take down information, and make sure your wishes are carried out. It's like having a spokesperson or a campaigner for you and your health. The best patient advocates are trustworthy, knowledgeable about health care, assertive, and good verbal communicators.
A billing advocate will start, naturally, with your bill, where they will look for errors such as duplicate charges, uncommonly high charges, and charges for tests that were cancelled. After that, this advocate can help negotiate with caregivers and your insurer to help you further lower your costs.
Why should I hire a patient or medical billing advocate?
If you have a serious surgery planned, or are in poor health and visit doctors frequently, you may want a patient advocate in your corner. This might be a spouse or trusted friend, an acquaintance who knows the industry, or a hired professional. If you are in good health but find yourself in a medical emergency and would like someone in your corner, ask the hospital staff if they have any advocates in-house. You can also hire an independent patient advocate who has only your interest in mind.
On the other hand, if you have already received care and are now facing unmanageable medical costs, you may want to hire a billing advocate. This type of advocate will normally charge for his or her services but may be able to save you thousands. Medical bills are the leading cause of bankruptcy in the U.S., and patients often have no idea what they'll be hit with financially until the services have already been rendered.
How much do patient and medical billing advocates cost?
Patient advocates are often members of your family, nonprofit organizations, or clergy and may not charge you for their services. In most cases, however, there will be a fee associated with patient advocates, and it usually depends on the amount of time they spend with you and your doctor. Advocates on the hospital staff may have their charges built into your bill. For this reason, costs may vary from as little as $75 for a single doctor's visit to a few thousand dollars for an extended hospital stay.
Medical billing advocates usually have more concrete charges. Some charge hourly, at a rate of $100 to $200. Others charge as a percentage of savings -- usually 25% to 35% of the price they got your total charges reduced by, but some charge as little as 15% of savings.
Where can I find a patient or medical billing advocate?
If you think you could use an expert in your corner, start with NerdWallet's Ask An Advisor forum. While it's an excellent place to find expert advice on your medical bills or health-care questions, you can also use the tool to get in contact with any of our advisors about becoming your personal health-care advocate.
You can also find patient and medical billing advocates through the National Association of Healthcare Advocacy Consultants or the Alliance of Claims Assistance Professionals.