When Should I Hire a Medical Billing Advocate?

Consider hiring a medical billing advocate if you’re experiencing any of the following issues:

• You don’t understand your medical bills, and the explanations given by your providers don’t make sense.

• Your health insurance is refusing to pay part or all of your medical bills and the reason doesn’t make sense or seems wrong.

• Your health insurance is refusing to pay part or all of your medical bills and is giving you the run-around.

• The hospital billing office (or doctor’s billing service) is blaming things on your health insurance company, and your health insurance company is blaming the same things on your hospital (or doctor’s office). Thus, you’re stuck in the middle, holding the bill.

• You’re overwhelmed with medical bills that you can’t possibly pay and you’re considering bankruptcy because of them.

• You have no insurance and you’re not good at negotiating. A medical billing advocate can negotiate lower bills in advance or after-the-fact.

• You’re so sick you no longer have the energy to deal with the volume of paperwork required to manage your medical bills and health insurance coverage, but you don't want family or friends to have to do it for you.

• You’re responsible for managing the medical bills of someone else (perhaps an elderly parent) and either can’t make sense of them or are overwhelmed by what’s involved with keeping track of them.

What Will I Need to Give to the Advocate?

Exactly what tools and information a medical billing advocate will need to help you depends on the particular circumstances of your medical bills and health insurance plan. However, you should expect that he or she may need at least some of the following:

• Your medical bills.

• Your explanation of benefits (EOB) forms.

• Your signed permission to speak with your health care providers and your health insurance company.

• Access to your medical records.

• Information about what you’ve paid already.

• Information about what steps you’ve taken to resolve the issue prior to getting the medical billing advocate involved.

What is the Cost of Advocacy Services?

• Cost varies depending on the complexity of your situation. Most advocates should be willing to have a free consult and give you an estimate based on your consult.