insurance

6 questions to ask a health advocate

Highlights
  • A health advocate can be a nurse, doctor, social worker or insurer.
  • Ask the advocate to give you contact information for former clients.
  • A good advocate can explain how your goal can be measured and achieved.

If you're facing an astronomical hospital bill, denial of insurance coverage or refusal of treatment, help is on the way. A new type of health professional called a patient or health advocate is helping to haggle with health care providers.

A health advocate can be a nurse or doctor, social worker or health insurance staffer. They do everything from booking appointments with medical specialists and reserving rooms in nursing homes to persuading insurers to cover pricey procedures and reducing medical bills by hundreds or even thousands, of dollars.

"Our advocates are typically registered nurses, but we also have Medicare and elder-care experts and insurance administration professionals who understand insurance contracts and benefits," says Martin B. Rosen, co-founder of Health Advocate, a firm in Plymouth Meeting, Pa.

"If you're looking for a nursing home, we don't just give you the number, we take the lead in resolving the issue," Rosen says.

But beware. There's no licensing for health care advocacy. "There are people calling themselves patient advocates who actually work for collection agencies," says Laura Weil, director of the health advocacy program at Sarah Lawrence College in Bronxville, N.Y.

Finding an advocate

If you're dealing with hospital bills, ask the hospital if there's an on-staff advocate. "Hospitals are interested in having satisfied customers who don't go to the attorney general," says Weil. "Its financial assistance office can help you negotiate costs, set up payment plans or underwrite the entire cost."

Check with your workplace. Many businesses offer a patient advocate as an employee benefit.

If you must find one independently, get referrals from someone who has used a patient advocate. Or, start with the Patient Advocate Foundation, a nonprofit in Newport News, Va., that offers free services like resolving billing errors and negotiating with insurers to approve access to medical treatments.

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Interview the health advocate

If your situation requires more handholding, it may be best to pay for an individual health advocate focused on your case. Health Advocate and a second firm, HealthCare Advocates in Philadelphia, conduct most business by phone and computer. If you prefer to meet an advocate nearby, search online for one in your area.

Before you pay for anything, ask some key questions to find the right advocate, and get all answers in writing. Here are six questions to ask:

1. What are your credentials? You need someone with experience working on the situation you're facing, so check his or her educational background and where he or she was trained, Weil says.

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