When to Hire a Medical Billing Advocate
When should I hire a medical billing advocate?
Hire a billing advocate when your bill exceeds $10,000, involves complex coding issues, or you have been fighting with the billing department for months without resolution. They charge $75-200 per hour or 25-35% of the money they save you on a contingency basis.
You have done everything right. You have reviewed your itemized bill, compared it to your EOB, identified clear errors, and even written a dispute letter. But the hospital billing department is unresponsive, and the insurance company is giving you the runaround. At some point, you may need to call in a professional: a medical billing advocate.
What Does a Medical Billing Advocate Do?
A medical billing advocate is a professional who works on behalf of patients to resolve medical billing issues. They are often former medical coders, nurses, or healthcare administrators who have an insider's understanding of how the system works.
Auditing Medical Bills
Perform a detailed, line-by-line audit of your medical bills to identify errors, overcharges, and fraudulent billing.
Negotiating with Providers
Negotiate with hospitals and doctors to lower the amount you owe, especially if you are uninsured or underinsured.
Appealing Insurance Denials
Manage the complex process of appealing a denied claim with your insurance company.
Correcting Billing Errors
Work with providers and insurers to correct coding errors, duplicate charges, and other mistakes.
When Should You Consider Hiring an Advocate?
While you can resolve many simple billing errors on your own, there are certain situations where it makes sense to call in a professional.
| Consider Hiring an Advocate If... | Why? |
|---|---|
| The Bill is Very High | If you are dealing with a bill for tens or even hundreds of thousands of dollars, the potential savings from hiring an advocate can be substantial. |
| The Dispute is Complex | If your dispute involves complex coding issues, multiple providers, or questions of medical necessity, an advocate will have the expertise to navigate the complexity. |
| You Are Not Making Progress | If you have been trying to resolve the issue for months and are not getting anywhere, an advocate can break through the stalemate. |
| You Are Overwhelmed | If you are dealing with a serious illness, the last thing you need is the stress of fighting with a billing department. Hiring an advocate can give you peace of mind. |
How to Find and Hire a Reputable Advocate
The field of medical billing advocacy is not regulated, so it is important to do your homework to find a qualified and ethical professional.
Step-by-Step Action Plan
- 1.Look for a Certified Professional: Look for an advocate who is a Certified Professional Coder (CPC), Certified Medical Billing Specialist (CMBS), or has another relevant credential.
- 2.Ask About Their Fee Structure: Advocates use different fee structures. Some charge an hourly rate. Others charge a percentage of the amount they save you (a contingency fee). Make sure you understand the fees before you sign a contract.
- 3.Check References: Ask for references from former clients. A reputable advocate should be happy to provide them.
- 4.Get a Contract: Always get a written contract that clearly outlines the scope of work and the fee structure.
Fee Structures to Expect
Hourly Rate
$75 - $200/hr
You pay for the time they spend working on your case, regardless of the outcome.
Contingency Fee
25% - 35%
They take a percentage of the money they save you. No savings, no fee.
Flat Fee
$300 - $1,000+
A fixed price for a specific service, like a bill audit or dispute letter.