How an Advocate Can Help You Save Money on Medical Bills

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Wading through the abundance of options when it comes to healthcare is overwhelming when you factor in things such as selecting a provider, obtaining referrals, and keeping track of follow-up appointments. Add an astronomical bill to the mix, and you have yourself a full-fledged headache. There is a desperate need for change when it comes to healthcare, starting with associated costs, but while we wait for the perfect system to be put into place, how can we take steps to minimize the cost of our own healthcare?

 

Knowing Where to Seek Help

Patients often consult family and friends when they are trying to find low-cost, high-quality healthcare. But when bills begin stacking up and balances start increasing, friends and family are likely just as lost for answers as the patient. Sometimes a professional is needed – someone who will be on the patient’s side to sort through all the details and negotiate on their behalf.

Because of this, an increasing number of patients are enlisting the aid of a medical billing advocate. These patients are learning first hand that an advocate will save them more money in the long run. Still, others remain leery of bringing in yet another “specialist” and creating another bill. However, some medical billing advocates only charge a fee if they find errors, such as the professionals at Medical Billing Advocates of America, and that fee is a small percentage of the total savings they find for you.

medical advoacy

What is “Medical Billing Advocacy”?

The field of health advocacy is fairly new, and right now there are many different backgrounds and levels of education among the advocates. A good number of them come from the medical field already, and many have extensive knowledge of the industry. Because of this, they are likely to already have an arsenal of surefire ways a patient can save money right off the top.

Advocates specialize in different areas. Some can help you with your entire experience, including intangible benefits such as moral support and a helping hand while some focus solely on finances. Whatever you decide, try finding one who has dealt with a case similar to yours. They likely have encountered many of the problems you are – or soon will be – encountering along your journey.

 

Understanding the Advocates Role

Not surprisingly, a common concern regarding advocates is that they are more expensive than they’re worth. You’re trying to save money here, not spend more of it, right? People who are not informed of all the benefits of having the help of an advocate can be missing out on great savings. Advocates’ fees aren’t always high.

In fact, their charges vary greatly from low, income-based costs to the higher costs of some private medical billing advocates. Many advocates only charge a percentage of the money they are able to save the patient. Sort of like an attorney who doesn’t charge the client unless they win the case (contingency-basis). This is ideal, because you can be confident that they’re going to do everything in their power to get that win.

 A good medical billing advocate will immediately request an itemized version of the medical bills in question.

Working With a Medical Billing Advocate

Most people find that once they make a decision to contact a medical billing advocate, they begin to feel a little more at ease. That’s because medical billing advocates know where to look to find errors in medical bills and they are confident that if there are errors on your bill, they will find them.

A good medical billing advocate will immediately request an itemized version of the medical bills in question. Then, they will analyze that bill line by line, studying various possibilities for error, such as clerical errors, miscoding and unbundled items. They will then ask you if you received the treatments for which you have been billed, right down to the amount of time it took to perform a procedure and the time of day you received certain medications.

Because the auditing experience with a medical billing advocate is so detailed, it’s a good idea to write down your experience in the healthcare facility as soon as possible, while it’s still fresh in your mind. Any time you are in the hospital, it’s a good idea to keep a notebook beside you and log any medications, procedures, treatments and supplies you received and at what time.

 

How to Work With a Patient Advocate

A patient advocate is slightly different than a medical billing advocate. Through strategic handling of each unique case, patient advocates have saved millions of dollars for consumers. Helping the patient choose a physician is one of the many ways they can help save money. For the most part, doctors can and will charge whatever they want for a service or procedure.

Advocates compare prices, and they have knowledge of which physician is likely to charge less for certain procedures and, therefore, can refer you accordingly. Furthermore, patient advocates have access to data on different doctors, and they can compare ratings with pricing to make a truly educated recommendation regarding cost and benefit, since quality is an absolute must in regards to your health.

A controversial issue is occurring in the healthcare industry in which many times, uninsured patients are being charged more than insured patients for the same procedure. For instance, an insurance company may pay a doctor’s office $350 for a customer’s procedure. At the same time, an uninsured patient can be at the same facility for the same treatment, but is charged a fee of $500. Same facility, same treatment, two different prices.

There is an obvious difference between these two prices for the same procedure. Insurance companies have people on staff that can negotiate if necessary. We consumers should have our own negotiator – a medical billing advocate who specializes in balancing out such discrepancies and helping the patient’s finances come out much better than they would otherwise.

patient advocate

 

Rampant Overcharges

What’s more, a large number of medical bills have some type of inaccuracy. Let’s face it, in an industry where it is not uncommon to charge a patient upwards of $20.00 for a Tylenol, why wouldn’t duplicate charges and frivolous fees exist? Since medical bills are usually laden with codes and jargon, an expert should interpret them.

It’s probably safe to assume the office sending you the bill isn’t going to give it a twice over just to be sure they’re not overcharging you, so we have to take matters into our own hands. Medical billing advocates often have a sharp eye for detail, negotiation skills and extensive medical knowledge, making them extremely effective when negotiating.

A medical billing advocate will review every charge on your medical bill to ensure all fees are fair and reasonable – a common missing element in medical bills. They make sure bills from any healthcare facility are charged correctly and will dispute billing errors. Not only will an advocate utilize their expertise to review your medical bills, they will also critique your insurance documents from top to bottom, so that you don’t pay a penny more than necessary or miss a single benefit to which you are entitled. They will analyze reimbursements from your insurance company to ensure they have paid accurately, according to your explanation of benefits. Often, a medical billing advocate will appeal a decision if they feel it is necessary.

overcharges

How to Handle Insurance Companies

If your insurance company is denying or minimizing coverage, a medical billing advocate will approach them to make sure you receive the compensation to which you are entitled. Because of the depth of their knowledge and negotiation skills, medical billing advocates frequently deliver significant relief to the patient.

Furthermore, out-of-network or uninsured patients might get relief from medical bill charges by negotiating for lower charges from medical bill charges by negotiating for lower charges from the medical facility. Insured patients have an insurance company working to reduce their billed amounts, meaning the healthcare facility is prepared to accept a lesser amount for services. A medical billing advocate can help you obtain a lower charge on your medical bills if you are uninsured or underinsured.

A medical billing advocate also can help you save on prescription drugs. Insurance companies at times may max the patient’s coverage out after a set amount. Unfortunately for the patient, that doesn’t mean you no longer need the medication. It just means that now you have to pay for it out of pocket.

Insurance companies may have tiers or levels under which certain medications will fall. Your medication may be on the most expensive tier or level. An advocate can do the research for you, helping you to find the least expensive place to purchase the medication. Paying for pharmaceuticals can be expensive, and a single prescription can cost hundreds of dollars. Many times, patients need more than one expensive prescription, increasing the amount a patient will have to pay.

 

Ways a Patient Advocate Can Help

Dental and vision savings are another area in which assistance from an advocate can be sought. Consumers can save around 30% on dental fees and 40% on vision costs when they implement the help of a patient advocate. These savings include prescription glasses and other necessities related to your vision or dental needs.

If the need arises, a patient advocate also can assist you to find a nursing home or assisted living facility. They weigh the pros and cons and make sure you don’t sacrifice quality or comfort. They will find out what your insurance will cover and help you find alternative avenues to pay your part.

It’s important to note that not all advocate organizations offer both patient advocacy and medical billing advocacy. Many will specialize in one area, just as Medical Recovery Services specializes in medical billing advocacy.

 

Advocates Can Help You Save on Hospital Bills

Advocates are there to assist with the hurdles that come along with getting timely healthcare tailored to your specific case. They stay abreast of the ever-changing insurance industry and the fine print that seems far too daunting to dive into each and every time a new notice is distributed. It is the advocate’s job to comb through the onslaught of information, locate changes and find the maximum benefit for the patient.

When all is said and done, an advocate can save patients 17% to 49%* or more on many of their healthcare expenses, and some will even go back and revisit old bills to ensure the patient wasn’t overcharged in the past. These advocates are truly there to negotiate on your behalf – to stand on the front lines of this battle and fight for you, ensuring the best possible outcome for your healthcare needs.

 

*These are examples of past cases and cannot be guaranteed.

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Pat Palmer
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8 responses to “How an Advocate Can Help You Save Money on Medical Bills”

  1. Curry Reeves says:

    On two recent occasions I have been required to pay a $150.00 deductible because of the billing codes that the provider used. When I asked why the services were billed as surgical procedures I was told that the A.M.A. has developed a coding system and that under that system the two procedures had to be billed as surgical. One procedure was a nasal endoscopy in which the doctor placed a scope in each nostril for probably ten seconds to verify that he saw polyps with his naked eye. This was billed as surgical and I had to pay a $150.00 copay. Ridiculous!!

    The second was a visit to the dermatologist that included him freezing several spots on my cheek and ear. Again, according to the A.M.A. coding system, these were billed as surgical and I had to pay the $150.00 copay.

    It appears to me that the A.M.A. has developed a coding system that is clearly designed to increase insurance company profits by requiring patients to pay copays for surgical procedures that are in no way truly surgical in nature.

    • Pat Palmer Pat Palmer says:

      Based on the information you have provided, it does sound like the services you received fall under the umbrella term “procedure”, which is listed in the surgical section of the AMA coding. It is unfortunate that your insurance has placed that copay on surgical procedures. I don’t think you would have any leverage in dispute (again, just based on the information provided), but I do suggest asking the provider to give you a courtesy discount or prompt pay discount, if you are prepared to pay a lump sum for a reduction in total costs.

  2. Pragati Katiyar says:

    My OBGYN doctor electronically ordered single test (CPT Code 76813: U/S Nuchal Translucency Single Fetus Test) to another business, since she did not have a machine to perform this test. I requested the order printout from my OBGYN as a proof. When I went to that business they did some tests on me without explaining what was being done and in good faith I assumed they are doing what was ordered by my OBGYN doctor. When other business later sent me the bill it also contained CPT codes (99244, 76801 and 93976) besides 76813 and charges for each of those had jacked up my entire bill. The other business also tried to offer me the options that are available in their facility in a tone which reflected their interest in trying to persuade me to become their patient while leaving my current OBGYN. Surprised by escalated charges billed to me, I discussed the bill with my OBGYN and she told that they were not necessary as she had already done those. Now it has been more than 6months of my writing to the biller, speaking with more than half dozen of collection agency and billing agents their providing one sides assessments, I am feeling like suing them for not only harassing me to pay for something that was not ordered by my OBGYN and also subjecting me to metal tension about unpaid bills and a potential for hurting my credit record etc. By the way I sincerely and within time had paid for the partial charges in the bill. I paid in full for the charge against CPT code 76813 that was ordered by my OBGYN. DO you think I have a valid case where I can sue the company after hiring a medical advocate and ask them to no only pay for court fees, but also fee for medical billing advocate and reasonable damages for mental tension from all this.

    • Pat Palmer Pat Palmer says:

      Since you went to another practice for the test, they can charge for the office visit of 99244. However, for the other two charges of 76801 and 93976, if an order was not sent, the test should not have been performed and therefore would be unbillable. I suggest sending a letter to the supervisor and copying the physician stating that this is a formal letter of dispute for the charges of 76801 and 93976 because your OBGYN did not order these tests and they were already performed at their office. Let them know that since an order was not received, you are requesting a full adjustment on those two charges unless they can send documentation of the physician’s order. If this matter is not resolved, I would consider involving a third party to investigate their billing practices.

  3. patti says:

    I was charged 3,000 for a sling for my shoulder surgery and 2,500 for a bot. After I took both back and complained the medical provider for these products was no longer the doctors offices provider. The money was paid with my pip from a car accident which was 1/2 of my pip. That left me with a 1,800 b ill from the doctor office. Geico requested a refund from the vendor who just called and yelled at the adjuster. The state of agriculture was where I finally got pointed to for help sent a letter with no success. The surgery center owned by the doctors where not in net work so the Insurance company billed out of network. and the physical therapy office told me they where in net work and they where not. Now the Lakewood Ranch Anesthesia group has billed me over 9,000 and the money they received form the insurance isn’t sufficient for them and they turned me over to collections. I have been hitting my head against a wall and battling for over one year. I need this to stop. There are ruining my credit. Please help

  4. Jacqueline says:

    I went thru a painful miscarriage, at first I went to an urgent care, I waited 50 minutes for the doctor and she looked at me with the blood, she said” I couldn’t do anything for you. I don’t know what is going on with you, you told me you got a miscarriage but I can’t verify that, please go to ER”. That was it. Later they sent me a bill for $350 for an office visit. I filed a complaint but they said that charge was correct, refusing to treat me involved a medical decision. I really want to hire an advocate. Since when making money is that easy, all you need is an urgent care sign, and refuse service, and charge.

    • Pat Palmer Pat Palmer says:

      Hi, Jacqueline. I’m so sorry about what you have went through and hope that you are healing well. It certainly doesn’t seem fair when we are billed large amounts from providers who took very little time with us. Please don’t hesitate to give us a call if you would like us to assist you in any way. 855-203-7058

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