When it comes to health care, you must often act as your own (or a family member’s) advocate—ensuring you understand your diagnoses and treatments while pushing for the highest quality care. But when it comes to your medical bills, there are certain times asking for help isn’t just useful; it could save you thousands of dollars.
Medical bill advocates are professionals who understand the complexities of medical billing. Patients and consumers can hire an advocate to audit their medical bills, seek out errors and negotiate lower costs.
Here are five times having a medical bill advocate on your side is a smart idea.
1. Your insurance denied a claim for something you thought would be covered.
Insurance denials have generally fallen over the past five years, but that doesn’t mean they are unheard of. The Department of Labor estimates about 200 million claims are denied annually on employer health plans alone. Your insurance company likely uses a claims review program to identify errors and questionable charges. These programs can trigger a denial for something as simple as a technical mistake in billing codes or a procedure deemed medically unnecessary. Regardless of your insurance company’s justification, not all denials are final. A medical bill advocate can help you identify why your claim was denied, and then negotiate with your insurance company on your behalf to get your claim adjusted.
2. Your bills seem outrageous.
Medical bills can get expensive, and most people expect a little sticker shock after a hospital stay or extensive medical treatment. But when your mouth drops open at the sight of your bill, it could mean there is a billing error within. Duplicate charges, typos, being charged for procedures that were ultimately canceled and fraud are all possible sources of seemingly outlandish charges on your bills. Billing advocates have years of experience picking out errors from bills, and can help you identify errors and get them removed to ultimately lower your bill.
3. You’ve already tried negotiating and haven’t had luck.
While some medical providers are willing to work with their patients, others are more resistant. Medical providers aren’t necessarily under an obligation to cut you a break, and they know this. Some are simply easier to work with than others. Medical bill advocates, accustomed to working with hospitals and providers, can sometimes get results when you hit a brick wall—they know the right people to talk to and the right questions to ask.
4. You’re worried that your medical bills will affect your credit.
Though FICO recently announced changes that mean medical debt will have a smaller impact on your credit score than in previous scoring systems, delinquent accounts and those in collections may still affect your score. Known as FICO 9, the new system will take effect this fall and will give less weight to medical debt than nonmedical debt, a distinction FICO 8 doesn’t make. It also means paid medical debt in collections will not affect your credit, whereas the current system doesn’t differentiate between paid and unpaid collection accounts.
Despite these positive changes, medical debt, and especially delinquent or unpaid medical debt, can affect your credit. Whether you’ve already made payment arrangements or are still grappling with what to do after the bills have poured in, an advocate can help you to understand what the debt means for your credit and assist in minimizing the impact.
5. You’re considering declaring bankruptcy due to your medical bills.
With 56 million Americans struggling to pay their medical bills, if you are considering medical bankruptcy, you are not alone. Earlier this year, NerdWallet reported medical bills as the leading cause of personal bankruptcy in the U.S., accounting for an estimated 1.7 million bankruptcies in 2013. But bankruptcy is a last resort, and lowering your medical bills or making them more manageable with the help of an advocate could be one way to avoid it.
A medical bill advocate in your corner
The bill(s) you receive in the mail after a medical procedure, hospital stay or treatment aren’t always the final say in how much you owe or what you’ll ultimately pay. You have options. Sometimes you can handle these options independently, negotiating with providers and making payment arrangements—but there are situations where having a professional in your corner can make the difficulties and obstacles associated with medical debt more manageable.
Image of couple and adviser via Shutterstock.