How ‘patient advocates’ help families navigate health care, billing

Dealing with the health care system — including bills that insurance might not cover — can be confusing. But patient advocates can help in several areas, according to Washington Consumers’ Checkbook.

“Some specialize in billing disputes or in really large hospital charges to help you make them affordable,” said Checkbook’s executive editor, Kevin Brasler. “There are also some that specialize in getting the best care possible out of a hospital or out of a physicians’ group.”

It would be hard to oversell the complexities of some financial disputes involving hospitals, care providers and insurance companies.

Hiring an advocate, even at $200 an hour, might be worth it, Brasler said, when your issue involves matters related to money.

One important consideration is to choose an advocate who is familiar with your insurance plan. Also helpful is experience with billing and knowing your hospital, which Brasler said is particularly important when seeking an advocate to help with medical issues.

“It’s really important that you hire someone who is connected somehow with that hospital system,” Brasler said.

COVID-19-related restrictions — such as limited or no visiting hours — may challenge a patient advocate who is unfamiliar with the hospital.

“The more people they know in that hospital, the better, because now you have someone on your side who knows the ins and outs of that particular facility. That can open doors and make things a lot easier if they know who to contact,” Brasler said.

Advocates who help families negotiate their way through the health care system are frequently retired nurses or doctors who have perspective to ask and pursue pertinent questions.

“To make sure the person is getting the best care, that they’re getting thorough care, that they’re not getting released too early,” Brasler said.

Early discharges are a common issue.

“One patient advocate said there’s even a term now for it — that hospitals are trying to release patients ‘quicker and sicker’ before they’re ready to be released,” Brasler said.

Hospitals might try to transfer patients to a transitional facility or home if their health insurance plan, Medicare or Medicaid payments for care are exhausted.

“Advocates can communicate directly with doctors and maybe even health insurance plans to make sure the patient gets the right care,” Brasler said.

Consumers’ Checkbook/Center for the Study of Services is an independent, nonprofit consumer organization founded in 1974. It has been an innovator in providing information to help consumers make smarter choices for more than 40 years.

WTOP readers have free access to all Checkbook articles and rankings through Aug. 31 here.

Kristi King

Kristi King is a veteran reporter who has been working in the WTOP newsroom since 1990. She covers everything from breaking news to consumer concerns and the latest medical developments.

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