All kinds of errors are found on medical bills. We see examples of billing more than once for the same service, billing for services or supplies you didn’t receive, using the wrong diagnosis and procedure codes, unwarranted denials by the insurance company, and plain old human error. All of these causes can add up to you, the patient, paying more than you should be for your health care services.

Medical billing advocates help individuals review medical bills for errors. We make sure that what you are being asked to pay is something that you actually owe, that you are not being over-billed, and that your insurance company (if you have one) is paying the amount it is obligated to pay.   You can think of us as medical bill analysts too. We analyze your bills and your coverage and make sure you get the benefits you are paying for.

National reports show that 90% of medical bills have errors, and they are not to your favor! Most people do not ask for and do not receive an itemized statement showing what they are being charged for. If you went to the grocery store and they handed you a receipt that said, “produce $40, meat $100, and canned goods $50, total $190″ you probably wouldn’t accept it. Why do we accept these types of bills from medical providers?

If you are interested in hiring a medical billing advocate, where do you find one? As with most professional services, the best way is through word of mouth. You can also check out billadvocates.com, the website for the Medical Billing Advocates of America. This site offers a feature that allows you to search for an advocate. Since most of what medical billing advocates do is done by telephone and email, it isn’t necessary to hire someone who lives near you. It’s best to hire someone who has a background in health care, insurance, or related fields.

Many  medical bill consultants conduct an initial NO-COST telephone review to help you determine if hiring a medical billing advocate makes sense for you.  In general, if your advocate doesn’t find savings, you only pay the costs associated with obtaining copies of your medical records.

Being an advocate for a senior requires more than making doctor appointments and helping to ensure the senior makes it to the appointment. That is the simple part. Some seniors may not want to press doctors regarding their care because they are afraid they will be punished by not getting the care they need.  Doctors may be so busy that they will sometimes miss crucial issues on the charts in front of them or may accept non-committal answers from a senior scared to death of hospitals and ending up in a nursing home and not look deeper for the underlying cause of health issues.

This is written not to disparage the health care professionals who care for seniors. However it helps the doctor to know someone is with the senior who cares enough to know their medical history and to ask questions about problems they are experiencing. Of course, the trick is to leave the dignity of the senior intact by first letting them provide as much information to the doctor as they are willing or able to supply and to ask as many questions as occur to them.

Important Point #1: If you, as an advocate, have POA over health care, you should keep copies handy, even scanned into your computer (both at home and at work), so that if you end up in an emergency room situation, you can print a copy before leaving home or work to provide the hospital. Health care professionals are bound by privacy laws that restrict their ability to discuss a patient’s health with anyone but the patient, spouse, or the person the patient has designated by power of attorney over health care matters. Having a copy of a POA over Health Care in your possession to place in the medical records which designates you as having POA ensures that all health care professionals who work with your parent/in-law/friend will answer your questions about the patient’s care even if they have to tell you that they do not yet know the answer to your questions.

Important Point #2: If you end up taking a senior to the emergency room as I did my father-in-law, be prepared for a long stay. As the advocate for the patient, you will need to be on hand for the history taking process to point out previous hospitalizations, recent illnesses and to do so for each nurse/doctor/lab tech who comes to the patient’s bed. All the bottles of medications that the patient takes should be gathered and kept with you in a plastic bag for entering into hospital records. So have someone find you a comfortable chair near the patient’s bed and do not switch off with family members until all the tests are done and the doctor finally arrives with a diagnosis. After the attending physician tells you what the diagnosis is, if all the symptoms are not addressed, ask him/her questions. You may need those answers to make informed decisions. You could be there for a long time.

Important Point #3: If the patient is admitted to the hospital from the emergency room, make sure that the hospital staff knows you are to be informed of any change in the status or care of the senior and be sure to put a telephone number in the records where you can be reached 24/7. If there are to be any changes in rooms or any invasive procedures done, especially at bedside, you want to be informed.

(I was horrified to arrive at the hospital one morning to find that my mother was placed in a room with two other patients overnight while preparing for a colonoscopy, meaning she had to walk past the other patients all night to go to and from the bathroom as the detergent she was given to drink cleaned out her system. In addition, the staff planned on having the colonoscopy performed bedside with only a curtain between them and the other patients’ beds. I made sure my mother was moved to a room that had no other patients in it while the procedure was performed. But she needed me as an advocate to take care of her dignity.)

Not all the duties should fall on the family member who has POA. At this point, our family emails back and forth about post hospital care, how Dad is responding to physical therapy, who will take Dad for routine labs (not quite as crucial as the results, unless the technician finds something immediately that becomes an emergency situation) and what to do about Dad’s 91st birthday. We, as a family, are quick to update one another on health issues related to the senior members of the family.

Important Point #4: For serious and critical illnesses or for long distance caregivers, there are professional advocates who can be consulted. Many can be found simply by doing an internet search using the words senior advocacy.

If you are a member of the sandwich generation, looking for further advice, I suggest doing an internet search for articles by Gail Sheehy on caregiving.  The most important point she makes in her articles is that caregivers need to take care of themselves. It will not help either you or your loved ones if you are constantly drained emotionally and physically. Learn to pace yourself and to enjoy life’s milestones for yourself and for the seniors you love. Right now, I am looking forward to my mother’s 80th birthday and hoping to have her to cherish for many years to come. Live long, Mom, and prosper.

Whether you have a loved one living with you full-time or you manage his/her care from 3,000 miles away, chances are you will be called at some point to act as that person’s advocate. So, along with the responsibilities that many of the more than 35 million caregivers in this country face on a daily basis, such as feeding, cooking, bathing or overseeing hired help, you will also need to be a voice for that person if he/she isn’t able to ask crucial questions or find important information.

Physically or mentally impaired older people need advocacy in many areas. Some examples include dealing with housing or transportation offices, the Social Security Administration, and sorting through Medicare and Medicaid. Many seniors are entitled to benefits they are unaware of and need someone to help them find information on vital programs. Some elders are eligible for reduced or frozen rent rates, reduction of transportation costs and/or specialized transportation to help them remain independent. Find your local area agencies on aging at eldercare.gov for more information on what your loved one may qualify for.

Perhaps the most important area for advocacy is the health care system. From prescribed medications to medical testing and hospitalizations, studies show that older Americans must be proactive in understanding the health care they receive to protect themselves from errors and injuries. Those who can’t do so need someone to speak up on their behalf.

Older people need a good advocate within the health care system. There is no doubt that being hospitalized puts older patients at risk for a whole host of problems, including infections, falls, confusion, weakness and bedsores. In addition, a 2006 report by the Institute of Medicine revealed that hospitalized Medicare patients experienced an estimated 400,000 preventable injuries each year from adverse drug reactions. Another 800,000 adverse events were found in nursing homes, plus 530,000 more in outpatient settings.

One of the major recommendations that came from this study was that “patients and their surrogates should in turn take a more active role in the process . . . to keep careful records of all medications.” Patients and caregivers can cut down on the likelihood of injury by creating a simple medical record that is brought to all doctor’s appointments and hospital admissions.

In addition to harm done by medications, what about all of the interventions that are offered to older patients or those with serious illness? We’ve all heard stories about someone who has had the wrong leg amputated or the wrong kidney removed, and are horrified that such things can still happen despite the high level of care available in this country. These are obvious cases in which people received the wrong care-care that only does them harm. In addition, another study showed a 13 percent increase in the number of procedures done on Medicare patients during their final hospital admission that did not result in a corresponding increase in life expectancy. We have more technology to use at the end of life, but it isn’t always the right choice.

Because of this, it is critical that older persons and those with chronic serious illness (and their advocates) become well informed when treatments and procedures are being offered. Some important questions to ask are:

What will be the added benefit of this?
What are the possible side effects?
Will it affect my ability to function independently?
What are the possibilities if I choose not to do this?

Another important step to take is creating advance directives-a living will or health care proxy, depending on which state you live in. Discussing these important issues with your loved one will be immensely helpful should the day come that you must make health care decisions on someone else’s behalf.

Sometimes making big medical decisions can seem overwhelming. One place to turn for support if you are grappling with various treatment choices is your hospital’s palliative care team. This interdisciplinary form of care, now a recognized medical subspecialty for physicians, is focused on relief of suffering for those faced with serious health issues. The services a palliative care team provides are usually covered by Medicare or other types of insurance and are billed just like treatments from any other medical specialist.