Patient Advocates: How Medical Claims Professionals Can Slash Your Hospital Bill

Doctor consulting with a patient.

Overwhelmed by your hospital, doctor, or other medical bills?  Before you freak out — or pay up — you should know that as high as 90 percent of all medical bills contain errors, according to Medliminal, a medical cost containment firm. And guess what?  The majority of those errors are in the provider’s favor —not the patient’s favor.  Fortunately, there are little-known professionals you can hire who specialize in finding and fighting the overcharges on people’s medical bills so you pay only what you owe.

They go by many names –medical billing advocates, claims assistance professionals, medical claims professionals, healthcare claims advocates—but those who have hired one have another word: godsend. These pros know how to read a murky medical bill, spot the glaring errors, and negotiate on your behalf. Some charge an hourly fee, ranging from $25 to $150, for their work, but others work on contingency. That means you pay nothing unless they negotiate a lower payment for you!  That, in turn, means they are highly motivated to do just that. Medical billing advocates who work on contingency charge a percentage of the amount they saved you —typically 15 to 35 percent.

Cynthia K. of Florida thought being diagnosed with breast cancer was the worst thing that could happen to her. But then the hospital where she had her 40-minute lumpectomy overcharged her. Before the operation, the hospital told her it would cost $5,000. Instead, she got a bill for $12,700 – right in the middle of her devastating course of chemotherapy. To make matters worse, Cynthia, an artist, was uninsured.  Desperate for help, she hired a medical billing advocate. Her advocate found all sorts of classic errors. The hospital had billed Cynthia for two first hours in the operating room. How many first hours can there be? There were drugs listed on the medical bill even though they weren’t in Cynthia’s medical record. And the hospital had charged Cynthia $192 for a postoperative support bra that her advocate was able to find for just $19 on the internet!  After a couple of weeks of research, this skillful, passionate advocate was able to cut her bill by $6,858 — more than half.

Those are just the mistakes for which one woman was charged.  Here are several other medical billing errors patient advocates say are shockingly common:

  • Misplaced decimals: One patient was given a medication that costs $87.40, but he was billed $874 for it!
  • Medical Mistakes: If a hospital procedure gives you an infection—or otherwise makes you worse instead of better— you shouldn’t have to pay for that.
  • Inappropriate Charges: Supplies like syringes, IV tubing, and gauze are usually included in the cost of a hospital room.
  • Upcoding: This is where a hospital bumps a procedure up to the next code level and charges for something more complicated which costs more.
  • Unauthorized Procedures: Procedures the doctor didn’t order.
  • Phantom Services: Services the patient did not receive.
  • Canceled work: The doctor’s orders are entered immediately, but if those orders are canceled, the cancellation may not make it into the record.

The above examples happen mostly in hospitals, but medical billing advocates can help you reduce doctors’ bills, lab bills, and other medical bills as well. In addition, many of these patient advocates will help you negotiate with your insurance company, if it has refused to pay for some or all of your care. To hear directly from an experienced medical billing advocate, about what kinds of bills are easiest to fight, I invite you to listen to Episode 18 of my podcast, Easy Money. I can’t describe what makes a good case nearly as well as someone in the trenches. If you want to find a medical billing advocate, I have created a detailed list with links at the bottom of this blog post. That should give you several options for hiring someone to help you in this time of need.

Elisabeth Leamy is a 20-year consumer advocate. She also recently launched a podcast and blog called Easy Money.