When Do You Need a Medical Billing Advocate?

What Is a Medical Billing Advocate?

Medical billing advocates can help you review medical bills for errors, confirm that insurance claims have been processed correctly, appeal or dispute health insurance denials and much more. They can also work with your health care provider and insurance company to resolve billing issues or negotiate lower bills.

Medical billing advocates are sometimes confused with patient advocates. Services offered by the two types of advocates sometimes overlap, but patient advocates specialize in helping people navigate the complexities of the health care system. Whereas medical billing advocates focus on the financial side of things, patient advocates might help their clients understand their treatment options, decipher medical records or get questions answered during a hospital stay.

Many patient advocates can handle medical billing and insurance issues. For example, they may review medical bills for errors, track your insurance and billing paperwork, negotiate medical bills or assist with denied claims. However, they might lack the resources or expertise a medical billing advocate has.

Patient advocates often work for health care providers or insurance companies and generally provide free services. Medical billing advocates are independent professionals who concentrate on billing and insurance issues. You'll have to pay for their services.

When Should You Consider a Medical Billing Advocate?

When should you use a patient advocate and when should you hire a medical billing advocate? Generally, a patient advocate helps at the beginning of a health care journey; a medical billing advocate steps in after a problem arises.

If you or a loved one has just been diagnosed with a complex medical issue, look for a patient advocate who handles both medical care and billing. They can help you weigh your options for treatment, get approvals from your insurer, manage insurance paperwork and more. Essentially, they help organize the care you need and ensure that it's covered by insurance.

Consider a medical billing advocate when:

• You're overwhelmed by the sheer volume of medical bills or by surprise medical bills.
• You don't have time to track your claims or spend hours on the phone with insurance companies and health care providers.
• You can't understand your medical bills.
• You are too ill to deal with insurance and medical bills and have no family members who can help.
• Your bills are so high you're thinking about declaring bankruptcy.
• You're caring for an ill relative and need help managing their medical bills.
• You've already tried a patient advocate but didn't get the help you need.
• You can afford to pay someone to help with your medical bills.

How to Find a Good Medical Billing Advocate

Looking for a medical billing advocate? There are plenty of resources.

• Many hospitals, nursing homes and other facilities employ patient advocates to help you resolve care and billing issues for free.
• Some health insurance companies have patient advocates on staff or cover the cost of hiring approved advocates. (Just keep in mind that advocates working for health care facilities or health insurance companies are ultimately paid by those organizations.)
• Your employer may provide medical billing advocacy services as an employee benefit.
• Nonprofit or religious organizations in your community might provide patient advocacy services.
• If you have a chronic condition or serious illness, look for programs specific to your situation. For example, MedCareLine Case Management helps patients with cancer, ALS, HIV/AIDs and more get discounts, set up payment plans, get insurance approvals and payments, and appeal insurance denials.
• Every state has a State Health Insurance Assistance Program (SHIP) that offers free, one-on-one assistance with Medicare-related issues.
• Many states have Consumer Assistance Programs (CAPs) that help consumers resolve health insurance problems and ensure they get the benefits they are owed.

In addition to seeking referrals from friends and family, you can find independent patient advocates and medical billing advocates through the following organizations:

• AdvoConnection: This organization has a nationwide directory of members the Alliance of Professional Health Advocates.
• National Association of Healthcare Advocacy Consultants: You can consult its database of its members, all of whom follow the organization's code of ethics.
• The Alliance of Claims Assistance Professionals: Claims assistance professionals are advocates who can help both insured and uninsured patients negotiate medical bills.
• Patient Advocate Foundation: The foundation provides free patient advocate services for those living with a chronic disease or major illness.

Before hiring a medical billing advocate, The Alliance of Professional Health Advocates recommends asking:

• What is your background, training and experience?
• What are the costs? (Get this in writing.)
• Have you worked on cases similar to mine?
• Have you worked with my insurance provider and/or health care provider before?
• Are you paid by anyone other than me?
• Can you provide references?

How to Get Help Paying Medical Bills

Almost 1 in 10 adults has medical debt, according to a Kaiser Family Foundation analysis of government data. To get help paying medical bills (and protect your credit score):

• Ask about discounts. Some providers will lower the bill if you can pay most of it in full. Others will reduce the total in return for a sizable down payment.
• Negotiate a payment plan. Many health care providers will let you pay your bill over time if you ask.
• Investigate financial assistance. This may come from nonprofit, government or charitable organizations. Many drugmakers have pharmaceutical assistance programs (PAPs) that provide drugs at low or no cost. Consult the Patient Access Network (PAN) or HealthWell Foundation for help paying medical expenses for specific conditions.
• Consider credit cards. If other options fail, those with good credit may qualify for a credit card with an introductory 0% annual percentage rate. This might allow you to repay medical debt without emptying your bank account or accruing interest (just be sure to pay it off before the 0% APR period ends).

As you work with a professional to handle your medical bills, Experian's free credit monitoring service can keep tabs on your credit. That gives you time to focus on getting better.