When a claim is denied, an out-of-network fee is too costly, or an uninsured patient confronts an unclear or towering bill, an advocate may be able to help.
Who are medical billing advocates?
Advocates come from a variety of backgrounds: insurance agents, nurses, lawyers and health care administrators. Medical Billing Advocates of America, a professional association, provides additional advocacy training. Members share knowledge and skills on tough cases.
How do they help?
- They look for errors by comparing the insurer's explanation of benefits to the bill, and they help lodge an appeal to insurers or health care providers.
- They negotiate charges with hospitals or doctors and can apply for "financial aid," known as charity care, with a facility.
- They appeal unusually high costs. Advocate Cindy Holtzman once found a $1,004.50 charge for a toothbrush.
- They help patients write letters to lawmakers seeking intervention from the lawmaker or his staff.
- Advocates contact news organizations. "That helps to jostle an insurance company," Holtzman said.
How do you find the advocate that's right for you?
Finding an advocate in your state may be less important than finding one with the skills and expertise – a nurse or lawyer, for instance – a case demands. The association also offers a paid membership that allows clients to e-mail questions to advocates and access resources to help make sense of their medical bills.
How much do advocates charge?
Consumers should look for fees in the neighborhood of 30 percent of the money an advocate is able to save, said Candice Butcher, the president of Medical Billing Advocates of America, although charges may range from 15 percent to 50 percent. Some advocates may also charge a fee, such as $10 per page, for analyzing billing records. Others have an hourly rate.
Once armed with such an analysis, many clients work directly with the insurer or provider to reduce the fees. Savings vary, too, but Holtzman says her record is a savings of $187,500 on a $250,000 bill.