Medical bill advocates: what they do, what they cost

Medical bills can take hours of calls, letters, and hold music. A medical bill advocate is someone you hire to do that work for you. This guide explains what advocates do, how they charge, and how to choose one. It also covers the free help you can try first. It's part of our guide on how to lower medical bills.

You don't need an advocate to question a bill. Many problems take 1 call or 1 letter to fix. But an advocate can help when a bill is large or you're short on time.

What does a medical bill advocate do?

An advocate works for you, not for the provider or your insurer. The work often includes:

• Reviewing itemized bills and each explanation of benefits (EOB) for possible errors
• Calling billing offices to ask for corrections
• Talking with your insurer about denials or claims that weren't paid right
• Helping with insurance appeals
• Helping you apply for hospital financial assistance
• Negotiating a lower amount or a payment plan

Not every advocate does all of this. Some focus on billing. Others also help with care decisions or insurance coverage. Ask what's included.

Why do people hire an advocate?

People usually hire help for 1 of these reasons:

• The bill is large. A hospital stay or cancer treatment can bring dozens of bills.
• The problem is complex. Several providers, 2 insurance plans, or a denial can take many rounds.
• Time is short. A due date or appeal deadline is close.
• They're caring for someone else. Managing a parent's bills on top of your own is a lot.
• They're stuck. They've called and written, and nothing has changed.

How do medical bill advocates charge?

There's no single price. Most advocates use 1 of 3 models, or a mix.

With a percent of savings, the key question is what counts as "savings." Is it measured from the first bill, or from the bill after errors you already found? Does it include fixes your insurer would have made anyway? Get the answer in writing.

Say Linda is handling her father's $8,000 hospital bill. Before she hires anyone, she finds a $500 duplicate charge. The hospital removes it, so the bill drops to $7,500.

She hires an advocate who charges a percent of savings. The advocate gets the insurer to pay a claim it had denied. The bill drops to $2,000.

Measured from	Math	Savings
The first bill	$8,000 − $2,000	$6,000
The bill when the advocate started	$7,500 − $2,000	$5,500

The difference is $500, the duplicate Linda found on her own. Any percent fee is lower if it's based on $5,500 instead of $6,000. That's why the agreement should say which number counts.

How to vet a medical bill advocate

Treat it like hiring any professional. Before you sign:

1. Ask about experience. How long have they done billing work? Have they handled bills like yours?
2. Ask about credentials. Some advocates hold a credential from a private board, like Board Certified Patient Advocate (BCPA). The Patient Advocate Certification Board keeps a list of people who hold it.
3. Ask for a written agreement. It should list the fees, the work, how often you'll get updates, and how you can end it.
4. Ask how they protect your records. You'll share medical and money details, so ask how they store and send them.
5. Read every permission form. Your provider and insurer may need your written OK to talk with the advocate. Check what each form allows and for how long.
6. Stay in the loop. Ask for copies of letters and notes from calls.

Be careful with anyone who promises a set result, or who wants a large fee before reviewing your bills.

What you can do yourself first

Many bills can be fixed with a few steps you can do on your own:

1. Get an itemized bill. See how to get an itemized bill.
2. Compare it with your EOB. Look for repeats, missing payments, and services you didn't get. Our list of common medical billing errors shows what to check.
3. Call about any error. If that doesn't work, see how to dispute a medical bill.
4. Apply for financial assistance. See hospital charity care.
5. Ask for a discount or a plan. Our guide on how to negotiate a hospital bill has scripts.

If you do these steps first, you'll know what's left to fix. That makes any help you hire more focused.

Where to find free help

Free help is available for many situations. Try these before you pay for help:

• State Health Insurance Assistance Program (SHIP). If you have Medicare, SHIPs offer free, personalized counseling, including help with billing problems. They aren't connected to any insurer or health plan.
• Your state's consumer assistance program. Many states have one to help with health insurance problems. The Centers for Medicare & Medicaid Services (CMS) lists them by state.
• Hospital financial counselors. They can explain the hospital's financial assistance policy and help you apply.
• Patient Advocate Foundation. This nonprofit offers free case management to people with chronic, life-threatening, or debilitating illnesses. That includes help with insurance denials and medical debt.
• Dollar For. This nonprofit helps people apply for hospital charity care for free.
• The No Surprises Help Desk. For surprise out-of-network bills, call 1-800-985-3059.
• Your insurer's member services. It can explain a claim or a denial. The number is on your insurance card.

When to get help

You can handle many bill problems yourself. It's worth paying for an advocate when the bill is large or complex, and free help hasn't solved it. It's also worth it when your time is worth more than the fee.

If you've been sued over a medical bill, an advocate isn't enough. Talk to an attorney right away.