What does a medical billing advocate do?

What a medical billing advocate does

A medical billing advocate is someone you hire to deal with a medical bill for you. Many come from jobs in nursing, insurance, law or hospital billing. They know how bills are put together, so they can spot things that look wrong.

According to KFF Health News, advocates compare your bill with your insurance statements to find errors. They also negotiate with hospitals and doctors, and they can help you apply for charity care. Charity care is free or low-cost care that a hospital gives to people with limited money.

No advocate can promise any result. Most of the work, such as checking the bill and asking for help, is work you can also do yourself. What you pay an advocate buys time and know-how, so a person with time to make a few calls may get the same help alone.

How medical billing advocates are paid

No single price applies to every advocate. Some advocates charge by the hour, and some charge a flat fee to review one bill. Others take a share of the money they save you. KFF Health News reported that fees based on a share of savings were common. That report is from 2009, so ask each advocate for its current terms.

Here are some questions to ask before you hire anyone.

• "How do you charge, and what will my total cost be?"
• "Do I owe you anything if you save me nothing?"
• "What training do you have, and have you handled bills like mine?"
• "Will you put the fee and the work you will do in writing?"
• "Will you need my medical records, and how do you protect them?"

Be careful with any company that asks for money up front or promises to erase your bill. A fee based on savings can make sense, but only if you understand it. Read the whole contract slowly before you sign it.

Look for hospital and community help first

Help from public or community sources is often enough. These are good places to start, and each one can tell you whether it charges anything.

• The hospital's own financial counselor or patient advocate can explain the bill and the hospital's help program.
• Your state attorney general's consumer office takes complaints and may know of free local help.
• 2-1-1 is a confidential phone service that connects people with local help, including help with health care.
• A State Health Insurance Assistance Program, or SHIP, gives one-on-one counseling to people with Medicare and their families.
• A legal aid office can help if you are being sued or feel a collector broke the rules.

The billing office can give you the name of a financial counselor. Nonprofit hospitals must have a written financial assistance policy, according to the IRS, and a counselor can walk you through it. Our guide on hospital financial assistance shows how to apply.

Doing the work yourself with our guides

Most billing problems come down to a few steps. First, get an itemized bill and check it for errors. Next, ask about financial assistance and a discount. Last, ask the office for a payment plan.

Our medical bill help guide explains where to start. Phone scripts that you can read out loud are in our guide on how to negotiate a medical bill. Notes from each call will be useful if you later decide to hire an advocate.

When a collector is already calling, read our guide on medical bills in collections to learn what the collector can and cannot do. That guide also lists steps that you can take today with no fee and no one else involved.

When paying an advocate makes sense

An advocate may help when a bill is very large or when the bill has many lines and many dates. They may also help after you have been told no several times, or when you are too ill or too tired to deal with it. A family member or friend you trust can sometimes do part of this work for free.

If the bill is small, the advocate's fee could take a big share of the savings. The free steps in our guides are the better place to start. A good faith estimate is a written estimate of expected charges that providers usually must give you if you have no insurance. If your bill is at least $400 above that estimate, you may be able to dispute it. Read our guide on the good faith estimate for the details.

What to bring when you ask for help

Whoever you ask, help comes faster when you arrive ready. Gather the bill, the itemized bill if you have it, any insurance statements and the letters from collectors. Add a short list of what happened with dates, and a note of who you spoke with.

Also write down your monthly income and your main costs. Hospital help programs usually ask about income, and a clear page of numbers makes the talk easier.

Plan ahead for your next visit

The easiest bill to fix is the one that never comes as a surprise. Ask for the price before you go, and request the office's cash price and a written estimate. To find a doctor with clear prices, use our directory.

If you think you are having an emergency, call 911 or go to the nearest emergency room right away. Do not let a bill stop you from getting care. This page is general education and is not legal advice.