Find financial help · Lesson 14 of 16
Who can help me navigate this?
The short answer
You do not have to do this alone. Help can come from your plan's member services, the provider's billing office, a hospital financial counselor, free government programs, a benefits office at work, or a patient advocate. The right helper depends on your problem.
Key takeaways
- Start with free help: your plan, billing office, or a state or federal program.
- Patient advocates can help with complex bills, denials, and appeals. Ask about cost first.
- You can name someone you trust to speak with your plan for you, using the plan's form.
People who already work on your case
- Plan member services can explain benefits, claims, and EOBs. The number is on your card.
- Provider billing office can fix billing mistakes, resend claims, and set up payment plans.
- Hospital financial counselor can help with financial assistance applications.
- Your employer's benefits or HR office can help with employer plans, FSAs, and HSAs.
Free public programs
- State consumer assistance programs and insurance departments help with private plan questions, complaints, and appeals.[1]
- SHIP counselors give free, unbiased Medicare help.[2]
- State Medicaid agencies answer Medicaid and CHIP questions.
Patient advocates
A patient advocate helps you understand bills, insurance, and appeals. Some work for hospitals, some for nonprofits, and some independently for a fee. Before you agree to work with one, ask about cost, experience, and how they will protect your information. The advocate questions checklist has more to ask.
Advocates, navigators, counselors, and clinicians
These roles are not the same:
- An independent patient advocate works on your behalf. You hire one, or a nonprofit provides one. Fees and training vary.
- A plan or hospital navigator, case manager, or patient representative is paid by the plan or hospital and follows its rules, but can still be very helpful.
- A billing or financial counselor works for a provider and helps with bills, payment plans, and financial assistance.
- A clinician, such as a doctor or nurse, gives medical advice. Advocates do not replace medical care. For urgent symptoms, call 911.
Letting someone speak for you
Plans usually need your written permission before they talk with someone else about your claim. Ask your plan for its authorization or representative form.
About AMME Navigator
AMME Health is developing AMME Navigator to connect people with patient advocates. It is in private beta.[3] This free learning site does not require it.
What can be different for you
Program names differ by state. Some states fund independent ombudsman programs for health coverage. Advocate fees and credentials vary; there is no single national license for patient advocates. Lawyers and tax professionals can give advice about your specific legal or tax situation.
More detail (optional)
Keeping a call log
For every call, write the date, the person's name, what they said, and any reference number. This helps whoever helps you next.
Be cautious
Be careful with anyone who promises a guaranteed result, asks for large upfront fees, or pressures you to decide quickly.
Words in this lesson
- Patient advocate
- A person who helps patients understand and handle care, bills, insurance, and appeals. Some are free; some charge a fee.
Related
Where can I go for help?
Free help is often close by: the member services number on your insurance card, the billing office for your provider, your state insurance department, and nonprofit patient advocates.
This is general education. For decisions about your own plan, taxes, or legal rights, check your plan documents or a qualified professional.