Do You Need a Medical Billing Advocate?

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More and more patients are turning to these paid professionals to provide help with interpreting and reducing their medical bills. But medical advocates’ fees can amount to hundreds or even thousands of dollars. Not everyone needs a medical billing advocate, but some situations call for extra help. 


What Medical Billing Advocates Provide

Medical billing advocates often have past work experience working for medical providers or insurance agencies—so they have an insider’s perspective. A medical billing advocate provides the following types of services:

  • Look over your medical bills, insurance explanations of benefits (EOBs), and medical records for accuracy.

  • Find errors and negotiate with your medical provider or insurance company to lower your costs. Errors may include medical billing code discrepancies, over-charges, inappropriate insurance claims denials, and other mistakes that can unnecessarily raise your bill.

  • Work with your medical provider to negotiate further discounts.

  • Put together a medical bill payment plan for your medical provider (including hospitals) that fits your budget.

Situations Best Suited for a Medical Billing Advocate

A medical billing advocate can be particularly helpful under the following situations:

  • You have unusually large medicals bills—such as after a long hospital stay or after a complex surgery.

  • You have detailed bills from several sources including separate doctors and healthcare facilities.

  • You or your family has several medical bills on an ongoing basis, such as for a chronic condition or due to advanced age.

  • You’ve already unsuccessfully tried contesting charges with your medical provider, or contesting a claims denial with your insurance company.
     

How Medical Billing Advocates Charge

Medical billing advocates may charge hourly fees for a specific bill, a monthly charge to regularly review all of your medical bills, or a percentage of the costs they help you recover. A medical advocate’s charges may be based on your needs and on the medical billing advocate’s type of services. Ask up front about the pay structure and payment policies.

Medical billing advocates tend to specialize in certain areas, such as hospital bills, working with the elderly, or certain geographic areas. Specialties underscore an advocate’s experience—where he or she may have worked in the past—and can really make an advocate more valuable for your situation. Find a billing advocate who focuses on cases similar to yours.

Medical Billing Advocate Qualifications

There is no certification, regulation, or formal training for medical billing advocacy. How do you evaluate an advocate’s qualifications? When you interview a medical billing advocate, ask about his or her years and type of experience, areas of specialization, and references from clients like you. If you need help with complex medical bills, the advocate should at least have documented certification in medical bill coding. 

Your employer may provide free or discounted medical billing advocacy services as a benefit. Before you find a medical billing advocate on your own, check with your company’s human resources team.

To find a medical billing advocate in your area: 

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 May 24

    1. Check medical bills for errors. Consumer Reports. http://www.consumerreports.org/cro/money/personal-investing/check-medical-bills-for-errors/overview/...

    2. Find a Claims Assistance Professional to Help You. Alliance of Claims Assistance Professionals. http://www.claims.org/refer.php

    3. Find and fix mistakes on your medical bills. Consumer Reports. http://www.consumerreports.org/cro/2014/05/find-and-fix-mistakes-on-your-medical-bills/index.htm

    4. Understanding Your Medical Bill. FAIR Health. http://fairhealthconsumer.org/reimbursementseries.php?id=66

    5. Understanding Your Medical Bills. American Academy of Family Physicians. http://familydoctor.org/familydoctor/en/healthcare-management/insurance-bills/understanding-your-med... and http://www.aafp.org/fpm/2004/0300/fpm20040300p31-rt1.pdf 

    6. Looking to Dispute Medical Bills? We Can Help. Medical Billing Advocates of America. http://billadvocates.com/

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