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Patient Advocates: Your New Best Friend for Managing Your Health Care Experience

May 23, 2014
Health, Medical Costs
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Not many people have heard of patient advocates yet, but the number is sure to grow. The world of health care can be daunting, intimidating and nerve-wracking, and having someone help you can seem like a pipe dream. If you’re reading this, chances are you’ve heard the buzz about the people who can help you navigate medical bills and health care in general. Chances are you’re facing something big — a medical bill or a procedure — sometime in the future, and you need a friend who knows the ropes. NerdWallet Health would like to introduce you to that friend.

Patient advocates serve a number of roles in the health care arena, but their main purpose is always the same: to be on your side. Nobody asks for injuries, emergencies or poor health, but they happen. And then, the bills roll in and sometimes in a big way. If you’ve ever found yourself looking at a large bill and wondering how you’re going to pay it, you’re not alone. Patient advocates can come in at any stage— from the first consultation with a doctor to the final receipt of the medical bill — to help you along the way.

Insurance counselors

The main function of insurance counselors is to help you understand your health insurance coverage. An insurance counselor offers education and confidential counseling on all things related to insurance. Most Medicare and Medicaid recipients can get access to insurance counselors at no cost through a state program, and some states offer counseling for those with private insurance. Many medical billing advocates (see below) offer insurance counseling as well.

Care advocates and coordinators

For a person with many health needs and medical specialists, organizing life around tests and appointments can take more time than the obligations themselves. Care coordinators streamline the hectic scheduling process that characterizes U.S. health care, and provide an organizational bridge between patients, doctors and hospitals. A care coordinator can schedule multiple appointments while remaining sensitive to the desires and needs of the patient, which is quite helpful for patients with many doctors.

Patient care advocates come in professional and non-professional capacities, but either way, they represent the most personal side of health care advocacy. If you know you have a serious medical intervention coming up, or you are in poor health, you may have a friend or family member who acts on your behalf. This is one kind of care advocate, while others are hired by the hospital or are independent contractors.

Linda Adler, founder and CEO of Pathfinders Medical, an advocacy group in Palo Alto, California, says care advocates play an important role. “Pathfinders ensures that our clients get the best possible care by overseeing communication between their medical providers,” Adler says. “By being the hub between the medical system and the patient and their loved ones, we decrease the potential for miscommunication that can lead to frustration, delays, and most importantly, medical errors.”

Medical billing advocates

Medical billing advocates usually come in at the last stage of medical care, the billing process. These experts are called after hospital services have been billed and the patient is left staring at a hefty charge, but they also help with smaller bills as well. You can, and should, question all hospital and outpatient bills and check them for errors against your explanation of benefits (EOB). Errors are more common than you may think, according to Pat Palmer, founder of Medical Recovery Services, a billing advocacy group based in Salem, Virginia. “It’s astounding that eight out of 10 medical bills we receive contain numerous overcharges.”

If you’ve looked over your medical bill and think it’s unreasonably high or can’t tell if it’s accurate, you might need a medical billing advocate. Not only will the advocate look over your bill for errors, but he can also lobby your insurance company and hospital for discounts as well. Medical billing advocates charge by the hour or as a percentage of the savings they find, usually in the neighborhood of 15 to 35%.

How to find the advocate for you

If you think you need one of the patient advocates listed above, chances are that seeking one out will help you. You can ask your hospital or medical center if they have patient advocates on staff, or you can head over to NerdWallet’s Ask An Advisor forum to find a Nerd-vetted expert.

 Image of medical billing paperwork via Shutterstock.