When to Use a Medical Billing Advocate

If you find yourself staring down a bill you don’t recognize, or one with charges you didn’t realize you’d incurred, you’re not alone. With experts finding errors in up to 80% of medical bills, hiring a medical billing advocate to review your bills can help you feel more confident that you’re paying the correct, fair price for your care.

The fact that up to 80% of bills1 contain errors sounds shocking, but when you consider how most medical bills are created, it starts to make a lot more sense. Medical bills in America are largely auto-adjudicated by computer software - without human review. The system is sloppy. The process is largely automated. And humans rarely review a bill before you get it.

That’s why it’s so important for you to assume that your medical bill is incorrect, then seek out the necessary resources or support to correct them. Luckily, you don’t have to fight that fight alone. Medical billing advocates can help you with a range of problems with your medical bills, from finding billing errors to negotiating payment plans. Here’s what you need to know about working with a medical billing advocate.

What is a Medical Billing Advocate? What Can They Do For Me?

Medical billing advocates help you solve problems with medical bills, often to save you money or fight back against bogus or incorrect charges. As experts in medical billing, advocates work with you directly to understand your concerns, review your bills, and resolve your problem - either with your insurance provider or healthcare provider directly.

Generally, patients turn to advocates when they feel that they’ve been overcharged, get a surprise bill, or are struggling to resolve a problem or billing error on their own. 

While medical billing and patient advocates sometimes overlap, medical billing advocates focus specifically on problems that arise with your bills and medical expenses and do not necessarily assist with coordinating or resolving issues related to your medical care, as patient advocates may do.

When You Should Hire A Medical Billing Advocate

Deciding whether to hire a medical billing advocate is a personal choice, but doing so can often help you save money and a lot of unnecessary stress. Often, it’s best to bring an advocate in as soon as possible, so that they can identify any problems that may arise with your bills before the headache starts.

While everyone’s healthcare experience is different, consider finding a medical billing advocate when:

  • You believe you may have been overcharged by a healthcare provider
  • You’re unsure if your bill is accurate
  • You are unable to successfully resolve a problem with a billing office directly
  • You received a surprise bill from your health insurance company
  • You believe you have been charged an unfair amount, either from an insurance company or medical provider
  • Your health insurance denied a claim and you believe it was due to an error
  • You are concerned about how to pay for your medical bills, or need help reducing your out-of-pocket costs, or structuring a payment plan to avoid medical debt

How a Medical Billing Advocate Can Help You Fight Medical Bills

There are a number of ways medical billing advocates, like Peachy’s billing experts, can fight for lower bills and reduce your out-of-pocket costs.

First, advocates start by talking with you to get a sense of your problem or when you believe you may have been overcharged. If you have any medical bills or documents, you’ll want to provide your advocate with those. Don’t worry if you don’t have any. Your advocate can help you track down all the necessary medical bills, superbills, explanation of benefits (EOBs), and, if necessary, your medical records.

What is an EOB?

An EOB is a statement from your health insurance provider generated after you receive any healthcare services for which a claim was submitted to your insurance. The EOB will describe what costs your insurance plan covers, any money you saved by visiting in-network providers, any out-of-pocket costs you may be responsible for, and the overall cost of the care you received.Your EOB may look something like this:

source: independenthealth.com

What is a superbill?

A superbill is an itemized list created by your medical provider or clinic of all the services you received, including information about your visit, CPT codes, and more. This is different from an EOB, which is provided by your insurance company.

A superbill might look something like this:

source: choosingtherapy.com/superbill/

Decode other confusing medical terms with the help of the Patient Glossary

Once you and your advocate have gathered all the necessary paperwork, they’ll get to work reviewing all of your bills to check for errors or ways you may be able to save money. Then, they’ll work directly with your medical provider or insurance company to address these issues. Sometimes, unfair billing can be resolved just by identifying a mistake made in a billing office. Other times, they have to challenge a provider or insurance company directly based on the way something was coded or the cost associated with the services rendered. Every case is different, and a good billing advocate will approach you and your medical bills with care and compassion.

How Much Do Medical Billing Advocates Charge?

Every advocate structures their payment differently. Some billing advocates charge an hourly rate, between $75 to $350, often working five to ten hours per bill. Peachy, on the other hand, offers free bill review and negotiation, only charges patients a small fee when they successfully lower a patient’s bill or out-of-pocket expenses. This fee ranges between 10% and 25% of the total savings amount.

We’ve spent that last year and a half making it easier for patients to pay their medical bills, and now we’re thrilled to be able to make sure those same patients are paying the correct amount, at a fair price. With 80% of medical bills containing errors, and 90% of bills being reduced in cost when negotiated, launching Peachy Pal was a no brainer. Do you have a bill, but aren’t sure it’s accurate? We’d love to help. Our new service is free, confidential, and you can start using it today.

Sign up Today