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What's the difference between a Medical Billing Advocate and a Patient Advocate?

The truth is, they can overlap, and one person can provide services that encompass both, or specialize in one or the other. Now that I’ve made that clear as mud, let me elaborate!

In the labyrinth of our healthcare system, the roles of medical billing advocates and patient advocates are both necessary assets. While both aim to assist individuals in navigating the complexities of the healthcare system, they do have distinct purposes. Here are the differences between these two allies:

Medical Billing Advocates:

Medical billing advocates specialize in untangling the financial aspects of medical care - depending when you ask for their assistance, this can mean helping you get pre-authorizations prior to medical care, or managing the expense after planned care or emergency care.

Their expertise lies in aiding patients with understanding their medical bills, negotiating with insurance companies and healthcare providers, and identifying any billing errors or excessive charges. Ultimately, their goal is to ensure that patients receive fair and accurate billing and to alleviate financial burdens associated with healthcare expenses. Unfortunately, the algorithms used by insurance companies often kick back many claims that should be covered before any human eyes even process them. My motto is, as you may already know, is when in doubt - appeal!

Patient Advocates:

Patient advocates support individuals as they seek and receive treatment. While they may address financial concerns, their focus extends to assistance with healthcare decision-making, getting second opinions, even attending appointments or at bedside in a hospital.

They provide emotional support, navigation of the healthcare system to secure the appropriate physicians, and advocacy for high-quality care during treatment. They may have some knowledge of issues related to insurance coverage, but their scope typically addresses a broader spectrum of patient needs.

Both medical billing advocates and patient advocates play vital roles in supporting you during a journey within the healthcare system. Some advocates and navigators can provide some overlapping support, though you should make sure you work with someone who has the appropriate skills to help with your specific needs.

Always state what your concerns are clearly, and ask questions so that you land in the right hands.

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