Cost to Hire a Private Patient or Health Advocate

Do you need to hire a private patient advocate to help with your healthcare? When you are sick or debilitated, it's impossible to figure out how to get the best from the healthcare system, or how to be sure you aren't being taken for a ride. Knowing that you may have been misdiagnosed, or that you haven't been told about all your treatment options, or that your bills are being tampered with can cause you enough stress as to make your condition even worse. How much would a private health advocate cost?

Why You May Need a Private Patient Advocate

Sometimes the only way to be sure you get the best service and outcomes possible from the healthcare system is to find someone else to help you navigate through the maze of providers, tests, treatments, and of course, medical bills you'll encounter.

But finding "someone else" and finding an expert, are two different things. Your sister or spouse may be able to help you. A neighbor who works in a healthcare provider's office might help you. But the most professional and objective help you're going to find will come from a private health advocate, also called a patient advocate or navigator. They are someone who knows the ins and outs of the system and can facilitate your path to recovery, or at least make your medical challenges easier to weather.

A quick distinction here: there are many kinds of patient and health advocates, but not all will be totally devoted to your care. Learn these distinctions and why a private advocate is what you're looking for.

Why Should You Pay for Private Advocacy Services?

While so many of the services we get for our healthcare are covered by our insurance, private advocates are not. That may initially sound like a negative — that in order to get help from a patient advocate or navigator you would have to pay for the service out of your pocket. But that's really to your benefit. Here's why:

When services are covered by your insurance, they are, by definition, limited. Your healthcare provider won't spend as much time with you because she will only be reimbursed X amount of money. Or, your stay in the hospital will be limited because your insurance only covers X number of days. Your insurance dictates your care.

But when you pay for something privately, then the only limit is your own limit, what you are willing to pay for. And when you hire an advocate to be on your side, it might be the advocate who knows how to squeeze an extra 15 minutes out of the healthcare provider appointment or the extra few days out of your hospital stay.

The whole point is to improve the quality of your care by having an expert on your side who is solely devoted to that improvement in the quality of your care.

Look at it another way: The reason you hire a real estate broker to help you buy or sell a home is because he or she is the expert. Sure—you could buy a "for sale by owner" without a broker—but what if something went wrong? You don't know what you don't know—but brokers do know because they deal in real estate every day. So it's worth the extra expense.

The reason you hire a CPA is because you want an expert to help you with your taxes. Sure, you could use tax software, or a pencil and a calculator, and do it yourself. But what if you missed a deduction? Or what if you don't understand a form? Again — you don't know what you don't know — but a CPA does know because that's her area of expertise. It's worth the extra expense.

Those examples address your home and your taxes. And neither is nearly as important as your health, or your life. So spending the money on a professional advocate is worth it — because you don't know what you don't know.

How the Cost of Advocacy Services Is Determined

The cost to hire a private advocate will depend on a few things:

1. The types of services and complexity of your need. There are perhaps dozens of services health advocates might provide for you. These range from explaining your treatment options to reviewing your hospital bills, from uncovering clinical trials appropriate to your need, to getting your insurance company to pay a claim you think should be covered. Each service will cost something different to accomplish, mostly as a function of the time it takes to accomplish it.

2. The background and expertise of the person you will hire. Just as would be true in any service business, the more credentials an advocate has achieved, the more it will cost to hire that person. A healthcare provider who has gone into private advocacy practice will charge more for her services than someone whose expertise has only been developed by helping his wife through her cancer diagnosis. The person who has worked in health insurance claims for 10 years will charge more than the person who just finished taking a weekend course in how to get the insurer to pay up.

Further, some advocates have developed specific niches to their work which becomes a benefit to you and will be worth a higher price. It could end up costing you less in the long run because that person is so good at what he or she does.

If you need to determine your next steps after a devastating cancer diagnosis, then working with an expert in shared decision making may cost you less and provide more quality of life. Decision aids are pre-developed by experts. You will save over hiring an advocate who would have to research your options on her own, then walk you through the pros and cons, and would charge you for the time it took her to do all that research.

It's important for you to establish and understand the credentials of any advocate you hire. That's one of the recommendations in a list of questions that help you choose the right advocate.

3. Your geographic location. Just as there are variations in cost for almost anything we buy based on where we live, the same is true for health advocacy services. A medical/navigational advocate with a nursing background in San Francisco or Boston or New York City will command a higher hourly rate than someone with an identical background who practices in Boise, Syracuse or Amarillo.

How Much Will You Have to Spend?

Because there are so many variables, it's impossible to put an accurate price tag on the cost of advocacy services, and it's even more difficult to assign them a value.

The value point is important. For example, you might pay a lawyer $500 to draw up your will, which you could have done yourself, online for $50. Or you might pay a lawyer $500 to keep you out of jail because you didn't pay for your speeding ticket. There's a lot of value in that $500 that kept you out of jail!

That's the kind of value you can get from a private advocate. Spending a few thousand dollars doesn't sound like so much if you know your life will last longer, or your quality of life will improve, or your pain may go away.

Please don't translate that to mean that an advocate will cost you a few thousand dollars. Her services might—and even so, that might be a bargain. Or, it could be that your needs require only an hours' worth of work, ranging from $75 to $500, depending on those variables described previously, or a month's worth of work that may range into the many thousands.

Interview Advocates to Determine Costs

Interviewing advocates costs nothing. Interview them, ask questions about how they can help you, their qualifications, and what they charge. Many suggest you pay them to do an assessment of your situation and possibilities. Even that cost will be worthwhile to learn more about what you don't even know to ask about. That's the reason you've gotten in touch with a professional to begin with.