Medical Billing Advocates Vs Lawyers: When to Use Each

Medical Billing
Medical Billing

PO Lawyer – If you are struggling to pay your medical billing, you are not alone. Medical bills are one of the most common reasons why Americans file for bankruptcy.

When faced with such a situation, you may consider hiring a professional to help you manage your medical bills.

We will discuss the differences between medical billing advocates and lawyers, and guide you on when to use each.

What are Medical Billing Advocates?

Medical billing advocates are professionals who specialize in medical bills and the medical billing system. They understand both the medical provider and insurance side of the billing system.

Types of Medical Billing Advocates

Medical billing advocates can help you in the following four areas:

  1. Billing Errors They can review your medical bills for any errors, including charging for services that were not provided, upcoding, unbundling, or balance billing. After identifying any mistakes, they can fight with the medical provider to correct them on your behalf, so you do not pay for anything you should not be.
  2. Appealing Insurance Claim Denials If your insurance company denies your claim, a medical billing advocate can guide you through the appeals process. They can gather and present the right evidence in the right way, increasing your chances of success and helping you avoid a paperwork-filled headache.
  3. Medical Rebates and Financial Aid Medical device manufacturers and pharmaceutical companies offer rebates directly to patients for devices used, and most hospitals have financial aid policies to help people on lower incomes. A medical billing advocate can identify and help you apply for such programs.
  4. Negotiating Prices Medical billing advocates can use data surrounding hospital costs, medicare rates, insurance negotiated prices, and usual and customary rates to convince the hospital to accept a lower price. If that does not work, there is also the potential to file in small claims court to force the hospital to lower their price.

Some medical billing advocates specialize in one area, while others have experience in all four areas and will adapt to your given situation.

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It’s essential to consider how the advocate fits with your situation, and a good advocate should be able to tell you this.

Advantages of Using a Medical Billing Advocate

Medical billing advocates are generally less expensive than lawyers and have experience dealing with medical billing issues.

They can quickly understand the best path forward to lowering your medical bills. They also have experience navigating the complex bureaucracy of hospital and insurance billing systems and speaking the right language to the right people.

Note that becoming a medical billing advocate requires no specific education. Anyone can represent themselves as such.

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However, some organizations have created standards and certifications to help consumers. Checking for such certifications can be a useful way to evaluate an advocate’s experience.

What is a Lawyer?

A lawyer is an expert on the legal system, with a deep understanding of the laws of the US, state, and locality they practice in. Like medical professionals, lawyers specialize in specific areas of the law.

Types of Lawyers

While medical bill negotiation lawyers do not generally exist, the type of lawyer that may work for you depends on your given situation.

Below are a few specialties you might consider:

  1. Personal Injury If you were injured in an accident and are considering suing someone (usually not the hospital), it may be worthwhile to talk to a personal injury lawyer.
  2. Medical Malpractice If you are fighting a bill based on a major error on the part of the medical provider (that is, you think the doctor or hospital committed malpractice in their treatment), you might consider talking to a medical malpractice lawyer. Note that there is significant overlap between personal injury and medical malpractice lawyers.
  3. Insurance Litigation If your insurance company is denying care coverage and you think litigation is the right route to go, consider reaching out to insurance lawyers.

The Advantages of Hiring a Lawyer

While often expensive, lawyers are experts at navigating the legal system.

In fact, medical billing advocates often cannot provide legal advice in a situation as doing so may be the unauthorized practice of law. They can and will use the court system to maximize your benefit.

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In addition, attorneys are often trained negotiators – so even if they are dealing directly with medical providers or insurance companies, they are often able to work out a better deal than you could on your own. They may also be able to spot legal issues that you wouldn’t even think to consider.

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