Hospital Bills Making You Sick?
You may need a medical billing advocate
Three years ago, Melissa Nussbickel developed a rare kind of cancer at age 28. When doctors couldn’t tell exactly what kind of cancer she had, slides containing cell samples were shipped to top cancer centers around the country for second and third opinions — and bills started rolling in.
Her family turned to a health care advocate, who took notes in meetings with doctors, offered comfort and got the bills cut by thousands of dollars.
“I don’t know what we would have done without her,” Melissa’s mom, Mary Ann Nussbickel, says of Lorie Gardner, the New Jersey-based advocate and RN the family hired.
For a fee of about $200 a month, Gardner kept track of the bills and phoned care providers and insurance company employees to haggle over costs. In the end, the family says she saved them upwards of $10,000 and loads of stress.
“You can’t put a price tag on it,” Mary Ann Nussbickel says of the help provided by a medical billing advocate.
Related: How Good Is Your Local Hospital?
What is a medical billing advocate?
Healthcare advocates, also known as patient advocates, are service providers who help patients navigate the world of healthcare, according to The Alliance of Professional Health Advocates, a trade group for the profession. They offer a variety of services, such as assistance with insurance issues, emotional support, help researching treatment options, lawyer referrals after a medical error and paperwork tracking.
A medical billing advocate is a type of healthcare advocate who focuses on the financial side of care — for example, helping patients and their families negotiate treatment prices, make sense of bills, navigate insurance benefits and correct billing mistakes.
Medical billing advocates can negotiate steep discounts upfront for cash-paying patients, says Teri Dreher, RN, a patient advocate in Illinois. For example, one patient was quoted $21,000 for a surgery, and an advocate who works with Dreher got the amount down to $8,000, Dreher says.
Advocates also can audit medical bills and spot errors that occur on as many as 80 percent of bills, says Beth Morgan, a Connecticut advocate. “Almost every bill I see has something wrong with it,” Morgan says. For example, in one case, a patient who had a heart attack was billed the $15,000 difference between what his insurance company paid and what the hospital normally charged, she says. The charge was wrong because the hospital had an agreement with the insurer to accept a certain amount, she says.
And advocates can negotiate with doctors, hospitals and insurance companies — and dispute charges or get equipment or services covered — after the fact. For example, one advocate got an insurer to cover a $48,000 hospital bed for home use to keep a patient out of the hospital, Dreher says. “That definitely wasn’t in the insurance policy, but we negotiated,” she says.
Patients sometimes are surprised at how much money a medical billing advocate can save them, Dreher says. “Everything is negotiable in healthcare today.”
How to hire an advocate
If you’re facing a major illness or injury and a stack of confusing bills, how do you hire a medical billing advocate? Here are four steps.
- Find candidates. Search the AdvoConnection directory, offered by The Alliance of Professional Health Advocates. You can search by zip code, which is important if you want an advocate who can go to doctor visits or pop in at the hospital. Get the names of at least three advocates and contact each one, Nussbickel recommends.
- Look at credentials. Health care advocacy is a relatively new profession, and there’s no national accreditation, Dreher says. “It’s still an evolving field.” But you can look at other credentials, such whether the advocate is a registered nurse or certified in medical coding, Morgan says. The fact that Gardner is a nurse helped her do a good job as an advocate, says Mary Ann Nussbickel, who also is a nurse.
- Ask about experience. Ask an advocate how long he or she has been in business, Morgan recommends. “Experience counts,” she says.
- Learn the costs. There’s no standard way for medical billing advocates to charge, and costs can vary quite a bit. Some charge by the case, while others charge a percent of savings or an hourly rate. For example, Morgan usually charges one percent of the total of the bills as an upfront fee, plus a percent of the amount she saves the client. And Dreher’s company charges about $200 an hour.
Finally, look for someone with whom you connect on a personal level, Nussbickel recommends. “See if they’re a fit,” she says.