October 27, 2017

Patient Advocacy and Patient Advocates

What is a Patient Advocate?

Patient Advocacy is having a Patient Advocate who works for you!  We don’t work for the Provider or the Insurance company.  We are sometimes referred to as Claims Advocates.  Insurance companies have their “Customer Service” representatives and Providers have their billing representatives.  Both are working for their respective employers.  As a result, neither is working for you.  The insurance company would like to make sure they don’t pay any more than they have too.  The Provider wants to collect as much as they can.  Having someone on your side who understands the system and the technical jargon can help.

When do you need one?

A Patient Advocate is needed when your claims have been through the “Adjudication” process and you feel they were not adjudicated properly.  This is technical jargon for, “your claim wasn’t paid correctly.”

What we do and what to expect.

A Patient Advocate can determine why the claim wasn’t paid correctly.  A Patient Advocate can work with both the Provider and Insurance company to resolve the claim.  The goal is to have a ZERO balance on all of your Provider claims/bills.

Not getting a zero balance on your claim can result in the Provider coming back to you later looking for payment.

How much does it cost?

We charge by the hour and require an upfront retainer.  In most cases, we work within the retainer and take care of the issue.  If not, we can tell you up front what we expect the time commitment to be for your case.

Will they help me pay my bill?

In a word, “NO”.  We are not that kind of organization.

What qualifies us to handle your claim(s)?

We have billers, certified coders, nurses, former office administrators, former hospital administrators and insurance experts who work to identify the issues and provide solutions to resolve the problem.

What kind of information do we need?

If you have insurance, we need a copy of the policy.  We will need copies of your healthcare claims or bills.  Finally, we will need copies of your EOBs (Explanation of Benefits).

Do I need an attorney?

Sometimes.  We work with a large number of law firms dealing with their clients’ healthcare claims.  They hire us because of our expertise in dealing with these matters.  If you have an attorney, we can work with them and if you don’t, we can recommend one.


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