What Is a Medical Billing Advocate? (Expert Guide)

Few things are more frustrating or confusing than getting hit with astronomical medical bills. Medical care costs have never been higher, and it’s one of the leading causes of stress and debt. In addition to being expensive, medical bills are also confusing and difficult to understand if you’re not familiar with the process. 

If you need help paying your medical bills, need help understanding what you’re getting billed for, or think that the bill is incorrect, you should enlist the services of a medical billing advocate. 

What Is a Medical Billing Advocate? 

medical billing advocate meeting

As their name indicates, a medical billing advocate works on your behalf with any issues related to medical bills. They can help you understand what you’re getting billed for, why it’s so expensive, and spot billing errors. A medical billing advocate can also help you dispute a claim with your insurance company, ensure they’re providing adequate coverage, and much more. 

Medical billing advocates are seasoned professionals that know what to look for when it comes to medical bills. Many are also former or current healthcare professionals, which means they’re familiar with the system. 

Are Medical Billing Advocates the Same as Patient Advocates? 

While medical billing and patient advocates both work on behalf of patients, they are different. Medical billing advocates work strictly on the financial and billing side of things, whereas patient advocates help patients while they’re at the hospital. They help you understand different treatment options, inform you of your rights as a patient, and ensure that all your questions get answered. 

The duties of a medical billing advocate and a patient advocate overlap regarding questions about medical bills. Patient advocates can help you decipher the complex language of healthcare billing codes and help you with insurance questions, but not to the extent of a medical billing advocate. Patient advocates also work for the hospital, while medical billing advocates are private professionals you’ll have to hire yourself. 

Services a Medical Billing Advocate Provides

Now that you have a general idea of what a medical billing advocate is and does, let’s look at our specific services. 

  • Assistance in understanding your medical bills 
  • Help you spot errors on your medical bills 
  • Help you understand what your insurance company will and won’t pay 
  • Hold your insurance company accountable to ensure they provide adequate coverage 
  • Inform you of assistance options if you’re having difficulty paying your medical bills 
  • Help you negotiate discounts from your hospital, doctor, or medical provider 
  • Help you formulate a repayment plan that fits your budget and is acceptable to your medical provider

As you can see, medical billing advocates aren’t one-trick ponies. We offer a wide range of services to make your life easier and less stressful regarding medical bills. 

10 Ways a Medical Billing Advocate Can Help You

If you find yourself in the following situations, it might be time to contact us for medical billing assistance and advocacy. 

1. Negotiating With Insurance

If you think hospitals and medical providers are tough, wait until you start dealing with your insurance company. Here are some situations where a medical billing advocate can help you with health insurance. 

  • Your insurance company is refusing to pay your medical bills 
  • Your insurance company is fighting with the medical provider, and neither will help with your bills 
  • Your insurance company is paying for some, but not all, of your medical bills 

2. Negotiating Without Insurance

Even if you didn’t have insurance when you received care, a savvy advocate could use various tactics to help reduce the bill to an affordable level. This can include looking at options for insurance that would retroactively cover your care, negotiating the bill’s price, eliminating errors or overcharges, and setting up a payment plan. 

3. Negotiating After Death

Dealing with the death of a loved one is emotionally and mentally taxing. However, if your loved one is leaving behind a pile of medical bills, it can be even more difficult for you to negotiate. On top of having to deal with funeral arrangements and costs, you’ll also have to deal with thousands of dollars in medical debt. 

A medical billing advocate will help you understand your rights when repaying someone else’s medical bills. We’ll also help you form a repayment plan, negotiate a lower price, and explain why you may or may not be responsible for your loved ones’ medical bills. 

4. Negotiating With a Collection Agency

Even if a hospital’s billing department has turned your account over to a collection agency, an advocate can help you. Collection agencies are typically less involved with understanding the nuances of your bill and more focused on collecting at least some of the payment to make their client happy or recoup their purchase price of your debt. However, an advocate can help to reduce these costs by working with the collection agency to identify potential issues with the bill and negotiate a lower payoff price for the account. 

5. Negotiating After Accident

A medical billing advocate can help negotiate your medical bills if you have had an accident. Some particular issues frequently arise during care that follows an accident that is particularly suited for their skills. These include:

  • Huge bills after trauma activation, complex surgeries or extended hospital stays
  • Bills from several different doctors, EMS/Air transport or different healthcare facilities. 
  • You have ongoing medical bills, such as the care of a chronic condition or from rehab
  • You have tried to contest charges with the provider or insurance company but have been unsuccessfu

6. A Patient Advocate Couldn’t Help You

Because patient advocates work for hospitals and insurance companies and offer their services free, we always recommend working with them first. However, there are specific questions and issues that your patient advocate may not be able to assist with.

Hospitals only employ a handful of patient advocates, so they get pulled in a dozen different directions. On the other hand, medical billing advocacy services are hired by you and work for you. We can dedicate more time and attention to your medical billing needs than a patient advocate.

7. Your Medical Bills are Large, or You Don’t Understand Them 

The most significant issue people face with medical bills is their magnitude and complexity. Hospital bills are often astronomical, even for routine surgeries, procedures, or treatments. On top of that, they’re challenging to read and understand for the untrained eye. To make matters worse, up to 80% of medical bills have one or more billing errors, so that you may have already paid for charges never received or billed more than once.

Medical billing advocacy services can help you understand what you’re getting billed for, why, and how to repay it. 

8. You Have a Chronic Medical Condition 

Medical bills are even more confusing and expensive for those dealing with chronic medical conditions requiring ongoing treatment. Chronic conditions that require continuing treatments such as chemotherapy, radiation, dialysis, blood transfusions, and many others are painful in more ways than one. They often result in a constant flow of hospital bills, and it’s easy to fall behind. 

You’ll be busy taking care of yourself or your loved one, so bills get put on the back burner. Whether you’ve fallen behind or are worried that you will, a medical billing advocate can help you formulate a repayment plan and keep track of your medical bills.  

9. You Don’t Know the Billing Assistance Options for Your State 

Adding to the complexity of medical billing and the billing department is that every state has its own rules and system. Therefore, you need to be careful if you’re doing a Google search for medical billing assistance. There’s a chance you’ll find the information you’re looking for, but it’s for the wrong state and doesn’t apply to you. A medical billing advocate, however, will know your state’s medical billing rules, policies, and assistance programs

10. You’re Sick or Ill 

Dealing with medical bills is never fun, but they’re even more complex and stressful if you’re sick or physically or mentally impaired. A medical billing advocate will take charge of your medical bills and handle them on your behalf. 

The Benefits of Getting Help From a Medical Billing Advocate

According to Becker’s Hospital Review, bill advocates and other health care professionals estimate that up to 80 percent of medical bills contain errors, typically ones costing you more money. Fortunately, advocates are well-versed in identifying and correcting those issues. If you’re on the fence about whether or not you need a medical billing advocate, here are the advantages of hiring one

Get help with billing and insurance paperwork

Most of the medical billing advocates at Amazing Healthcare Consultants are former healthcare workers. This means they have an intimate knowledge of how the medical billing system works. Thanks to this experience and expertise, we can ensure that you won’t be overcharged and help you set up a repayment plan that works for you. 

Reduce the amount you have to pay for medical care 

Hiring a medical billing advocate will also ensure you’re not being taken advantage of by your medical provider or insurance company. We’ll ensure that everyone is doing their part and have integrity, so you don’t get the short end of the stick. 

Get help resolving disputes with insurance companies

If you have ever worked with your insurance company to work through a denial or issues with a claim, you already know how difficult that can be. In addition to being current or former healthcare professionals, our consultants are also expert negotiators. We’ll negotiate with your insurance company to get you lower medical bills and a fair repayment plan.

Have someone who understands your situation fighting on your behalf

Medical billing advocates work every day to help their clients. This means that we’ve worked with a wide range of patients who have had a variety of different issues that they were facing. The aftermath of an accident, illness, or operation can often leave people feeling down physically and mentally. Medical billing advocates provide compassionate help to get people the peace of mind they need.

Feel less stressed about dealing with medical bills

If your medical bills are causing you extra stress and anxiety, it might be time to turn to a medical billing advocate. We will act as your medical billing concierge service and take the burden away from you. 

Things You Need to Prepare For Your Advocate

Preparation is crucial to give your advocate the complete picture to help get you the best possible outcome. While each case can vary, some essential information is best to gather before your meeting. Here’s a brief list of some of those items:

  • Your medical bills
  • Health insurance information that includes primary and if applicable secondary insurance
  • Your health insurance company’s explanation of benefits aka EOB forms
  • Permission to access your health records and speak with healthcare providers and insurance companies
  • Financial information about what you’ve paid and your current financial situation
  • Explanation of the steps you’ve already taken 

Additionally, it is essential to understand that medical billing advocates charge a fee. However, their services generally far outweigh their cost due to the generated savings.

How Much Do Medical Billing Advocates Charge? 

The amount you’ll pay for a medical billing advocate will vary depending on whether they charge an hourly rate—which can range from $75 to $350—or a percentage of the amount they save.. It is essential to ask about their costs upfront, so you know what to expect.

FAQs About Medical Billing Advocates

How to Choose the Right Medical Billing Advocate 

There are several ways to hire a trusted and reliable medical billing advocate and assistant. 

  • Ask your hospital or healthcare provider for a recommendation. 
  • Conduct a Google search to find all the options in your area. 
  • Call different healthcare consultants and ask about their rates, services, and experience. 
  • Look for free advocates from state and federal assistance programs. 
  • Ask your employer and insurance company if they offer medical billing advocacy. 

While these are all great options, the best way to find the right medical billing advocate is to contact us at Amazing Healthcare Consultants. We employ some of the best and most knowledgeable healthcare advocates and consultants. We’ll help you understand your medical bills, form a repayment plan, deal with your insurance company, and much more! 

Final Thoughts About Medical Billing Advocates

Nothing will turn your world upside down faster than unexpected medical bills. Even when you know they’re coming, medical bills can shock you because they are expensive and confusing. If you want to ensure that you aren’t getting taken advantage of or need help understanding your bills, a medical billing advocate can help. 

We have knowledge and experience that patient advocates and other medical professionals don’t possess. Contact us for a complete list of services and find out how we can assist you with your medical bills.