Patient advocates help people deal with doctors, hospitals, insurers

Patient advocates help people navigate murky waters of hospital bills, insurance statements and medical claims

Navigating the murky waters of hospital bills, insurance statements and medical claims can be jarring.

When Thomas Fefer's wife of 22 years was diagnosed with pancreatic cancer last summer and died just 66 days later, the onslaught of bills and bureaucratic hurdles was overwhelming for him.

"The things I was suddenly facing upon her death were truly insurmountable for me to consider," says Fefer, 63, a director of accreditation for the Tri-County Better Business Bureau in Santa Barbara. "An extraordinary number of expenses were piling up."

He needed help. An online search led him to a little-known industry of patient advocates and billing specialists that provide guidance on dealing with doctors, hospitals and insurance companies.

They handle negotiations and work to find satisfactory billing agreements. Often a fee is involved, but many employers will cover the cost.

"It's about dealing with the sheer volume of paperwork," Fefer says. "When a family member is beset with a terrible illness, it's never just one bill. It's a host of clinics and doctor and hospitals."

Fefer chose Martine G. Brousse, a patient advocate in Santa Monica, to make sense of his wife's medical bills.

Professionals such as Brousse work with patients and their families. They fight denied medical claims, file appeals, secure insurer authorization for medical care and generally help navigate complicated insurance rules. Some help find medical care, such as specialists and nursing homes.

These patient advocates — also called medical billing advocates or claims assistance professionals — have been around for decades. But the field has taken off in recent years as patients face higher out-of-pocket medical costs and the healthcare system becomes increasingly difficult for the average person to navigate.

"People just don't understand what's on their bill. The language is written in medical terminology. Sometimes clients just want a translation," says Maureen Lamb, a medical billing advocate and chief executive of Medical Bill Support in Holderness, N.H.

Larger organizations and an estimated 300 independent advocates practice nationwide, according to the Alliance of Professional Health Advocates, an advocate trade group.

There is no uniform training or licensing requirements for advocates or specific type of service they offer.

A host of organizations provide education and support to advocate professionals, many of whom are former nurses, attorneys or medical coding professionals. Some are certified in medical bill coding by organizations such as the American Academy of Professional Coders and the American Health Information Management Assn.

Private advocates may charge by the hour, with rates ranging from $75 to $150. Some work on retainer or charge a flat project fee. Another common practice is to take a percentage of the savings they achieve.

Increasingly, employees have access to these services on the job for free as part of their work-based benefits. More than half — 52% — of employers with more than 500 workers offer the service, as do 27% of companies with 10 or more employees, according to the 2014 national employer health plan survey by consulting firm Mercer.

The trend of providing workers access to advocates has increased as high-deductible health plans have become more common, says Alexander Domaszewicz, a principal with Mercer.

Offering the benefit, he says, is employers' way of saying "We'll give you someone to go shoulder-to-shoulder with to navigate the healthcare system because we know it's not easy and intuitive."

It is also a way to minimize lost productivity as employees spend hours at work on the phone fighting with their health plan or medical providers.

The response to these services has generally been positive.

"Companies that have implemented these programs have found them successful" among people that use them, says Shari Davidson, vice president at National Business Group on Health, a Washington nonprofit that represents the health policy interests of large employers.

Still, the profession's very existence is a damning statement about a healthcare system so complicated that professionals are needed to help people get and pay for care.

For example, advocate Katalin Goencz says she routinely fights on behalf of clients in need of treatment for mental health and substance abuse.

"Insurers routinely deny them," says Goencz, who is co-president of the advocate trade group Alliance of Claim Assistance Professionals in Stamford, Conn.

Lamb of Medical Bill Support says much of her time is spent fighting clients' hospital and doctor bills. "They don't know what the bills mean and how to get help. They've tried on their own and get the runaround," she says.

Santa Barbara businessman Fefer is sold on the idea, saying working with a billing advocate definitely saved him money. In the end, though, his advocate did so much more for him, he says. "How can you quantify the peace of mind that she brought me?"

Resources and links

Here is how to find a patient advocate or medical bill specialist.

Check at work: Many large and mid-size companies offer medical advocate services. Check with your human resources department.

Hire one yourself: There are organizations with lists to search for advocates in your area.


•AdvoConnection directory:

•Medical Billing Advocates of America:

•Health Proponent:

Twitter: @lisazamosky

Zamosky is the author of "Healthcare, Insurance, and You: The Savvy Consumer's Guide."

Copyright © 2016, Los Angeles Times