Guide to Hiring a Patient Advocate

You may not really know what services you need, but you no doubt know the problem or challenge you’re experiencing. Is your situation related to financial issues, including health insurance and/or medical bills? Or clinical issues, such as your diagnosis, treatment, healthcare providers, or a healthcare facility? Or both?

Sometimes the line isn’t completely clear between financial and clinical issues, like when your health insurance denies a request for a certain rehab facility or medication and you have to choose an alternate treatment or place to get care.

Don’t worry! We’ll help you sort out what’s really going on and how to get resolution.

Original Medicare covers patient advocacy services for those who have Part A & Part B. If you have this type of insurance, you want to look for a patient advocate that can bill your insurance. Securing a patient advocate through Umbra means you can use your Medicare to pay for the services.

If you have a Medicare Advantage Plan or any other type of insurance, you will need to pay privately. See below for guidance on questions to ask about costs.

Many patient advocates focus on either financial or clinical issues. Some work on both. Make sure whomever you hire works on the types of issues you have.

Some health advocates have clinical training and experience, like nurses and doctors. If you have a complicated health condition or need an expert to review your medical records to help you determine the best treatment plan, you may want to hire an advocate with clinical training.

Some advocates used to work in healthcare provider organizations or health insurers, so they know how the system works from the inside. If you’re fighting a medical bill or an insurance decision that didn’t go your way, you may want to hire an advocate who has experience from working in these types of organizations.

Other patient advocates turn their personal experiences navigating care for themselves or a loved one into their career. These advocates know the health system and can be great healthcare navigators and care coordinators.

Whatever your need or your preference, there are advocates who are equipped to help you.

Most of the work a patient advocate does can be done remotely. If you need help with medical bills, insurance claims, or even new diagnosis navigation most of the work can be done anywhere. By opening up to remote patient advocates, you may find someone with the best expertise for your situation.

If you need someone with specific knowledge of a local healthcare provider or insurer, you may want someone who has worked in your area, whether or not they are based there.

If you are seeking care coordination or help with in-person appointments, you may also need a local patient advocate. Just check before hiring a patient advocate that they provide in-person services.

Also be sure to check before hiring a patient advocate whether that advocate travels, how far, and if they charge a different travel rate for travel time.

It’s important that you feel a connection with your advocate. Do you feel heard and understood? Do they give you confidence and comfort? Is it easy for you to communicate with them? These are some things you can only get by meeting with someone - either on the phone, video call, or in person.

Many advocates offer a free meeting that you can use to get a feel for the advocate’s style and how they might be able to help you.

You can also call Umbra Health Advocacy, for a free initial consultation and to be matched with a patient advocate if you are unsure. Just call 332-286-2408 or fill out a Help Request.

Any interview or even a brief consultation may be helpful to point you in the right direction, but don’t expect an advocate to solve your issue or answer all your questions in 15 minutes. Any complex situation will probably require more time. 

Your initial meeting with a patient advocate may be between 15-30 minutes. That can go by fast. Plan ahead to get the most out of that time. See our Advocate Interview Guide below for specific questions you can use, but here are the types of things you may want to find out:

a. What are their credentials?

There’s no one right profile or credential for an advocate. Great advocates can have a wide range of credentials or backgrounds. That said, it’s fair to ask an advocate about their background, training, and experience providing services like the ones you need. It’s also fair to ask how long they’ve been practicing as an advocate. Don’t necessarily rule out advocates who are newer to advocacy practice; many advocates come from long careers in other parts of healthcare and can draw on that extremely valuable expertise to work on your behalf.

There are currently no specific licensing requirements to practice as an advocate, but there is a Board certification and a range of certifications that advocates can pursue.

b. How does their expertise match your needs?

It’s important that you explain your situation at least briefly. Ask the advocate if they have experience with similar cases. Were they trained in this type of situation? Have they worked with other clients with similar issues?

c. How do they work with clients?

Do they have a set process for gathering all your information? What will they need from you and how will they ask you for it? How do they communicate their progress to you? What will they do if they bump into obstacles to getting resolution for you? When are they available to speak with you? Will you set meeting times or can you call them whenever you want?

These questions will give you a good sense of what to expect when hiring with this patient advocate. Make sure it feels like their approach will work for you.

d. What do they charge?

If you have Medicare, be sure to ask if they take Medicare for payment. Umbra advocates do and you should use your benefit.

If you don't have Medicare or your advocate does not take Medicare, you will have to pay out of pocket.

Patient advocate costs can vary depending on the patient advocate (their expertise, location, and level of experience) and on your situation (how complex or straightforward it is). Rates range from $100 to $450 per hour. Much like accountants or attorneys, advocates have varying rates as well.

Patient advocates may set an hourly rate or a project or service fee. Sometimes, advocates will charge you based on their success, such as a percentage of a medical bill savings they’re able to achieve. But more often, health advocates charge for their time.

Advocates can’t always predict exactly how long your situation will take to resolve, but professional advocates will probably be able to give a good estimate or range of time they will need. Ask for that estimate so you know what to expect. Can you afford this advocate? Does it feel worth it to get the help you need? Only you can decide that. But you should feel comfortable discussing fees with professional advocates.

Are the fees you pay to them their only payment? It’s important to know if a healthcare provider, insurer, or other organization pays all or part of their fee. That’s not necessarily a problem (it would help offset the costs), but it does introduce potential conflicts of interest. You deserve and need to know if the advocate is working solely for you or if they answer to anyone else as well.

Independent patient advocates are bound by an allegiance factor, which means that they work only for the patient and in the patient’s best interest.

e. What are their terms

Most advocates will ask you to sign a contract and agree to certain terms and conditions. Review those terms carefully and make sure you understand them and feel comfortable with them. If you have questions, ask the advocate.

If you hire a health advocate through Umbra Health Advocacy, you can read our terms and conditions. If you have questions, get in touch! Email us at team@umbrahealthadvocacy.com.

f. Do they have time to help you?

What is the patient advocate’s current caseload? Do they have time to work with you and give you the attention you need? It's important to ask this before hiring a patient advocate.

We collect client reviews of our member advocates. Before hiring a patient advocate, read what others have to say about working with the patient advocate you’re considering on the Umbra Directory or in Google Reviews. Advocates may also be able to offer references from other clients they have helped. However, keep in mind, health advocates will protect their clients’ privacy and may not be able to share client contacts with you for that reason.

Do you like what you read and hear? Does your gut say this is someone you want by your side as you navigate your healthcare challenges? If so, go ahead and sign up with the advocate. Get the help you need and deserve.