WMBFNews.com, Myrtle Beach/Florence SC, WeatherWhat is a patient billing advocate and when do you need one?

Last year, Evelyn went in for a routine outpatient procedure. When the bills came in, she saw she'd accidentally been charged for an unrelated treatment. Not sure how to handle the issue, she hired a patient billing advocate, who quickly got it removed for her.

If you haven't heard of a patient billing advocate, you're hardly alone. But simply put, this person is an expert in helping people analyze their medical bills for accuracy.

In many cases, it's a necessary service. Many patients feel confused about the bills they receive. If you're ever hospitalized, you might get a statement you don't fully understand. But whatever you do, you shouldn't choose to ignore it.

What does a patient billing advocate do?

If you're concerned about the accuracy of a hospital or other kind of medical bill, hiring an advocate might be worth considering. These experts are able to act as your medical accountant. They're well versed in the ins and outs of medical billing and know how to:

• Review a statement for billing errors
• Negotiate cost reductions with hospitals and clinics
• Help you work out realistic payment plans
• Work directly with collection agencies on your behalf
• Help you find charity care for expensive treatments
• Process your insurance forms

If they seem versatile, it's because they come from a variety of professions in the health care industry. They're often effective because they know how hospitals and clinics are run. That's because many of them have previously worked as:

• Hospital administrators
• Insurance analysts
• Accountants
• Billing coders
• Doctors and nurses

But you may not need to hire one right away. If you get a bill you think has errors, try resolving it on your own first. Sometimes a phone call to your insurance company or the hospital itself might be enough. You may not need any outside help at all.

Hiring an advocate

Most patient billing advocates charge an hourly fee for their services. But there are some who work on a percentage basis, charging a portion of what they recover.

Your billing advocate may ask to see your medical records. Reviewing them often helps determine exactly which treatments you have had. If you decide that's necessary, you'll need to sign a waiver granting them access.

That's why you need to be careful when choosing a patient billing advocate. Start by asking the staff at your doctor's office or an accountant for a referral. Or check the state-by-state listing at the Medical Billing Association of America Web site (billadvocates.com).

Look for someone who:

• Has at least several years of experience
• Understands state and federal billing laws
• Has previously worked in a billing environment
• Can provide references

You might want to interview a few candidates before deciding on someone. It might be helpful to explain your situation and ask whether the person has handled similar cases before. Questions like this will help you determine which candidate is right for you. That way, you can get the kind of assistance you need.