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Medical-Billing Advocate

What’s that again? Surrounded by inscrutable stacks of bills from hospitals and doctors’ offices and your health-insurance provider? An advocate can help. According to the Medical Billing Advocates of America, 8 out of 10 medical bills contain some sort of error. An advocate will scour bills for overcharges and nonbillable and duplicate charges that violate the ethical guidelines of the American Medical Association as well as Medicare law (which is established by the federal government in the Social Security Act) and state insurance guidelines. He will also review those baffling insurance statements to guarantee that what your policy is supposed to cover is actually paid by the insurer and doesn’t come out of your pocket.

When to hire: Maybe you’ve spent hours on the phone with your insurance company and you’re no closer to getting a claim processed accurately. Or you’re unable to get a medical-billing error resolved. “Advocates complete training to negotiate with these businesses,” says Pat Palmer, the founder of the Medical Billing Advocates of America (MBAA), a professional organization.

Expect to pay: Approximately $50 to $150 an hour or 10 to 35 percent of the amount your bills are reduced by.

How to find a good one: First go to billadvocates.com, the site of the MBAA, to find a consultant in your state. Then, since this is a fairly new profession, one without national professional standards, be sure to ask for at least three client references before hiring an advocate. When you start working with one, you should receive a free consultation. If you proceed, you will sign a contract that states what specific services the advocate will provide, the fee, and how it will be paid.

Take note: Depending on the fee structure you agree upon, you could still be responsible for the advocate’s fee, even if she ultimately can’t remove or reduce any of your medical charges.