“ . . . a 2014 NerdWallet study found mistakes in 49 percent of Medicare claims. Groups that review bills on patients' behalf, including Medical Billing Advocates of America and CoPatient, put the error rate closer to 75 or 80 percent.” (NBCNews.com)
When you review your medical bills, you may have questions about how much your health insurance covered — and why more wasn’t. When you ask your providers, their answers may not really clarify the matter, or you may disagree with their reasoning. Or the scenario may play out like this: The medical billing office blames your health insurance company while your health insurance is blaming the doctor and/or hospital.
Meanwhile, you’re stuck in the middle with medical debt you aren’t even sure you owe — and that’s when a medical billing advocate can help.
A billing advocate can help in the following ways:
- Review your medical debt
- Check bills for “spot errors, over-charges, duplicate charges, unreasonable charges, and even fraud”
- Help to determine if your health insurance company has paid what it should; if not, why not?
- Advocate for you in getting errors and inappropriate charges addressed
- Appeal denials of health insurance claims
- Negotiate with medical professionals to reduce your outstanding balances
Your billing advocate will need copies of your medical bills and explanation of bills (EOB) from your insurance company. You will likely also need to give your advocate permission to speak to your healthcare providers and insurance company and to access to your medical records; payments made; steps you’ve taken to take to resolve this issue; and so forth.
You will need to pay this person for services rendered, although patient advocates can often save more money than they’d charge. And in some instances, they can find significant issues. For example, one patient advocate found a $1,004.50 charge for a toothbrush.
Finding an Advocate
If you’re still employed, check to see if your employer offers free or at least reduced-in-cost advocacy services. Also check if your health insurance plan offers this service. If this doesn’t help, then a vice president of the Medical Billing Advocates of America suggests that you immediately request an itemized detailed statement, which would allow you to analyze the bill line by line. You can also contact your insurance company to ask questions about how the bill was processed and why.
By this point, you will likely know if you need to hire a professional advocate to help. Typically, the initial review of the bill is done without charge, and then the service may take a percentage of any savings the advocate secured for you. Don’t wait too long to address the bill though, as this could have a negative impact on your credit report.
An increasing number of patients are using paid professionals to help understand and potentially reduce medical bills. Some advocates charge an hourly rate, rather than taking a percentage of costs recovered, so be clear about how you want to be charged. Also note that medical billing advocates tend to specialize in niche areas, whether geographically, demographically or something else entirely. It makes sense to find an advocate who specializes in a way that can be helpful for you.
The article also notes the following situations where a patient advocate may be most helpful:
- Your medical bills are “unusually large,” perhaps because of a complex surgery or long hospital stay.
- You have detailed bills from multiple doctors and/or healthcare facilities.
- You have large medical bills on an ongoing basis.
To find an advocate in Ohio, you can contact the Alliance of Claims Assistance Professionals or the Medical Billing Advocates of America. Or you can ask friends and family for recommendations, or request recommendations from your local hospital’s billing department.