What is a Medical Advocate & How Are They Paid?

The 2013 release of pricing information is clearly helping savvy individual consumers and medical advocates pay less on their medical bills. Medical advocates are often attorneys, or other individuals with a background in the medical billing industry, who work with consumers to lower medical costs. Being able to compare prices among hospitals helps consumers and medical advocates negotiate more effectively with hospitals and doctors.

Press coverage on the wide variation in hospital charges by region is teaching the public just how sloppy, and even downright fraudulent, medical billing has become.

What medical advocates understand (and the majority of individual consumers don’t realize), is that the standard for what consumers must pay for being hospitalized is not whatever the hospital charges in the bill, but what charges are “fair and reasonable” for that hospitalization. The hospitals and health care providers don’t check to be sure their bills are correct, and so there are often problems.

Hospital and medical care provider bills are rife with duplication, charges which are a result of hospital and doctor mistakes, and inflated charges.

Unfortunately, a majority of hospital bills contain such inaccuracies. Recent studies show 8 out of 10 hospital bills are excessive and contain errors. While there have been medical bill advocacy firms since the mid to late 1990s, now those firms are so confident they can save consumers money that cases are paid on a contingency fee basis.

Most medical bill advocacy firms agree to charge no fee up front, and not to get paid unless they find mistakes in the bill and negotiate a discount for their client. Then their fee is a portion of the savings (usually 25% to 30%). The rate of errors in hospital bills is so high there is now a mini-industry built around helping ordinary folks deal with crazy excessive medical bills.

For folks that want to review and question their medical bills without hiring someone to help, cost estimating resources are slowly coming on-line. At Healthcare Bluebook (www.healthcarebluebook.com), one can get an estimate of a fair price for hospital services, physician services and anesthesia services for specific medical procedures in a geographic area by zip code.

At Fair Health Consumer Cost Lookup (www.fairhealthconsumer.org) one can estimate the costs of medical procedures by zip code. This latter website requires knowing the CPT code for the procedure (see discussion of CPT codes below). A limited number of CPT codes can be looked up through this site. Clear Health Costs (www.clearhealthcosts.com) provides zip code based hospital pricing information (drawn from the Medicare datasets released by the government in 2013).

Our office is expert at helping find insurance to pay these bills, or at negotiating a reduction in proper cases where there is inadequate insurance.

Please call us today at 916.921.6400 or toll-free at 1.800.404.5400, or use our online contact form for a free consultation.

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