A patient advocate is someone who helps you understand your health care options, navigate the medical system, and fight for your rights as a patient. They can help with everything from understanding a confusing bill to filing an appeal when your insurance denies a claim.
Patient advocates come in different forms. Many hospitals have patient advocates (sometimes called patient representatives or ombudsmen) on staff to help resolve complaints, explain treatment options, and mediate between you and your care team. These services are free.
Independent patient advocates work outside the health care system. They're professionals you hire to help with complex situations like negotiating medical bills, managing insurance disputes, coordinating care across multiple providers, or helping you understand a serious diagnosis and treatment options. Independent advocates typically charge hourly fees or flat rates.
Your insurance company may also have patient advocates or member advocates who can help you understand your benefits, find in-network providers, navigate prior authorization, and guide you through the appeals process if a claim is denied.
For families navigating a new diagnosis, a complicated treatment plan, or a confusing insurance situation, a patient advocate can be invaluable. They understand both the medical and insurance systems and can translate between the two, something most people shouldn't have to figure out on their own during a health crisis.
If you need help understanding your coverage, dealing with a denied claim, or making sense of medical bills, that's exactly what Wise Health Choices does. Call us at (305) 330-1277.
Hospital-based patient advocates and your insurer's member advocates are available at no extra cost. Independent/private patient advocates are typically paid out of pocket; their fees aren't covered by health insurance, but the savings they can negotiate on medical bills often exceed their cost.
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