Medical Bill Advocates in New York: Free Help First, and When Paying for It Makes Sense

What a medical bill advocate actually does

A medical bill advocate works the paperwork between you, the provider and the insurer. The job has five parts: get the itemized bill, find errors and charges the insurer should have paid, apply for the hospital’s financial assistance, appeal insurance denials, and negotiate whatever balance is left.

In New York the third part does most of the work. Every hospital licensed in the state must run a financial assistance program. Up to 200% of the federal poverty level, an uninsured patient owes nothing; up to 300% the charge is capped at 10% of the Medicaid rate, and up to 400% at 20%. An insured patient whose out-of-pocket costs over 12 months exceed 10% of income gets the same tiers on their share. An advocate who does not know this law will negotiate a discount on a bill that the law has already reduced. How the law works.

The free advocates, and what each one is for

Community Health Advocates is the closest thing to a public medical bill advocate. New York designated it as the state’s health insurance consumer assistance program in 2010, under the Affordable Care Act. It runs a toll-free helpline at the Community Service Society and works through community organizations around the state. According to the organization, it serves people in all 62 counties in more than 35 languages, with or without insurance and without regard to immigration status, and has helped more than 550,000 New Yorkers since 2010. The service is free and confidential, and it is not selling anything. All the numbers in one place.

When paying an advocate makes sense

Free help has limits. Lines can be busy, cases take weeks, and a free program handles the bill in front of it rather than managing your whole year. A paid advocate can make sense when:

• The bill is large and your income is above 400% of the poverty level, so the financial assistance law does not reduce it, and the amount justifies a fee.
• Several insurers and providers are involved, such as an accident with car insurance, a workers’ compensation claim and a health plan.
• A family member is managing care for someone seriously ill and has no time for the paperwork.
• The provider is out of state, so New York’s hospital rules do not apply.

There is no New York license for this work, so the title alone tells you little. Some advocates hold a private credential, Board Certified Patient Advocate, which shows training rather than results.

What to check before you hire one

What you can do before calling anyone

The first three moves cost nothing, and every advocate will ask you for them anyway:

1. Ask for the itemized bill by name, in writing. The statement in the envelope is a summary. Reading an itemized bill.
2. Put the bill next to your insurer’s explanation of benefits. If the hospital asks for more than the “patient responsibility” line, that difference is the first dispute.
3. Apply for financial assistance on New York’s uniform application, at any stage, including after the bill goes to collections. The hospital must decide within 30 days of a complete application.

Then, if a collector calls, ask for validation of the debt in writing. What happens if you don’t pay lays out the timeline that protects you while you do this.