Help Figuring, Fighting Your Medical Bills

It shouldn’t have to be this way, but some people need to hire someone to figure out their medical bills and fight the charges. Medical bills are designed for the bureaucrats and computers at insurance companies, Medicare, and Medicaid, not for the actual consumers of medical care. So when a patient has care that isn’t covered by someone else, the patient needs to be sure the items on the bill are accurate and the prices are what they should be.

A medical billing advocate or assistance company can help. Some charge by the hour while others take a percentage of the reduction they’re able to negotiate. But it’s an unregulated industry. Anyone can set up shop as a billing advocate and call himself an expert. Here’s a review of what the profession is, how someone could help, and what you as a consumer should know.

Yet finding the right advocate can be tough, and those in the direst situations can ill afford the typical $75- to $130-an-hour rate. “This business is painfully slow-growing,” says Becky Stephenson, co-president of the Alliance of Claims Assistance Professionals (ACAP), an advocate trade group. “There are a lot of people with problems but not a lot of people willing to pay you to help them.” Despite long experience, Stephenson herself has trouble making a good living purely from advocacy, so she supplements her income by serving as an expert witness in medical lawsuits.

Employees working at sizable companies may already have access to a health advocate. Just over half of U.S. companies with more than 500 employees offer it as a benefit, according to Steven Noeldner, a senior consultant for Mercer’s Total Health Management practice. Many employees don’t know the benefit exists, he says, and the services generally aren’t as customized as those of an independent billing advocate.