What does a medical bill advocate do, and where can I find a free or trustworthy one?

What does a medical billing advocate do?

A medical billing advocate works on your side of a medical bill. Depending on who they are, they may:

• read your bills and your insurer's explanation of benefits and explain what each line means;
• find mistakes, such as duplicate charges or care you didn't get, and ask for corrections;
• call the provider or your insurer for you, and help you appeal a denied claim;
• help you apply for the hospital's financial assistance, a discount or a payment plan.

Some advocates are private professionals you pay. Others work for hospitals, nonprofits or public programs and help for free. Expect to sign a form that lets them talk with your provider or insurer about your care.

Who can help with which problem?

Start with the kind of problem you have.

Where can I get free help?

• At the hospital. Ask the billing office for a financial counselor. They can help you apply for the hospital's financial assistance and set up a payment plan. Our guide to charity care explains the application.
• For a serious illness. Patient Advocate Foundation's case managers give free, one-on-one help with insurance, denials, applying for Medicaid, Medicare or a Marketplace plan, and programs for basic needs. You need a confirmed diagnosis and to be in treatment, starting soon or recently finished, and to be a US citizen or permanent resident treated in the United States or a US territory. It limits how many new cases it takes each day Source 33.
• For insurance problems. CMS keeps a state-by-state list of consumer assistance programs that help people with health insurance problems; for states without one, it points to other help such as the state insurance department Source 44.
• For a Marketplace plan. People trained and certified by the Marketplace give free help with applying and enrolling. Find them at localhelp.healthcare.gov.
• For Medicare. Your State Health Insurance Assistance Program gives one-on-one Medicare counseling at no cost to you. Find yours at shiphelp.org.
• If you are sued. Legal aid programs give free legal help to people who qualify. Find one in your state at LawHelp.org.

Our list of organizations that help pay medical bills has more free help, including help applying for hospital financial assistance.

How do paid advocates charge?

We have not found a professional body that publishes typical fees, so we don't give amounts. Before you agree to anything, ask:

1. How do you charge: by the hour, a flat fee, or a share of what you save me?
2. If you charge a share of the savings, how do you count the savings, and is there a cap?
3. What do I pay if you don't save me anything?
4. Will you put the fee, the work and how to end the agreement in writing?

Compare the fee with what free help could do first. Many people get a bill corrected or lowered by asking on their own, as the last section shows.

What credentials should I look for?

• Board certification. The Patient Advocate Certification Board awards the Board Certified Patient Advocate (BCPA) credential through an exam, keeps it current through continuing education and publishes a list of people who hold it. It is a voluntary certification Source 55.
• A practice you can check. The Alliance of Professional Health Advocates is a membership organization for private advocates who run their own practices, and its site links to a directory search Source 66.
• Experience with your kind of bill. Ask how many cases like yours the advocate has handled, whether they work with hospital bills or insurance appeals, and whether you can talk to past clients.

A listing in a directory is not a guarantee. Ask the same questions of anyone you consider.

What should never be in an advocate's contract?

Walk away from a contract that:

• promises a result, such as a set amount off or a cancelled bill;
• asks for a large payment before any work is done;
• tells you to stop paying the bill or stop talking to the provider, without explaining what could happen if you do;
• lets the advocate sign agreements, make payments or settle a bill for you without your approval each time;
• asks for your bank login or a card number to keep on file;
• has no clear way to end the agreement, or no clear fee.

A good contract says what the advocate will do, what it costs, who may see your records and how either of you can end it. Keep a copy.

Can I do it myself first?

Often, yes. In a national survey, the share of insured adults who challenged a bill they thought was wrong and got it reduced or removed was 38% (Commonwealth Fund, Gupta et al., April 18 to July 31, 2023). In another survey of people who contacted the billing office about a bill they thought was a mistake, the share who got a correction was 73.7% (Duffy, Frasco and Trish, August to October 2023) One 2023 survey of US adults; these are outcomes people reported, not audited results.

1. Get the details. Ask for an itemized bill; our request letter has the words.
2. Check it. Compare it with your explanation of benefits, line by line. Our guides on how to read a medical bill and medical billing errors show what to look for.
3. Call and ask. Ask for corrections, financial assistance, a discount or a payment plan. Our guide on how to negotiate a medical bill gives the order to follow.

If you are helping a relative or a friend, ask the provider what it needs from the patient before it can discuss the bill with you.