Advocates Can Help Patients Correct Medical Billing Mistakes, Coverage Issues

LOS ANGELES (CBSLA.com) — If medical bills are overwhelming you, or you have tried and failed to fight a bill or been denied coverage, there is help.

CBS2 health reporter Lisa Sigell spoke with a patient as well as her advocate to find out more about how the process works.

Kenya Costa, a 37-year-old Realtor from Echo Park calls her daughter Kennedy her blessing, and says her life's a blessing, especially because Kenya suffers from rheumatoid arthritis that was diagnosed four years ago.

"RA is the kind of pain that will bring you to your knees," Kenya said. "It's unbearable."

But she has it under control. Her medication is expensive, but it's always been covered by her insurance. So imagine her shock when she got a big bill in the mail.

"I get the bill and I'm blown away," Kenya said. "I've got a $24,000 bill. How are you going to come up with $24,000 at the drop of a hat?"

As busy as she was, with work and the little one, Kenya tried to handle it on her own.

"I couldn't get anywhere," she said. "I've tried calling the insurance company, the billing department at my doctor's office. I'm not moving, and I'm so stressed out."

Then she heard about patient advocates from her mom, a social worker. She found Prissi Cohen of ProPatient Advocacy (http://www.propatientadvocacy.com) , who's been doing advocacy work for more than 20 years.

"A patient advocate is someone who can help you navigate through the maze of healthcare," said Prissi.

That includes billing, so Kenya asked Prissi to take on her case, but first Prissi had to hear her story.

"I had to believe that she had right on her side, that it wasn't just that she had received a medical bill and she didn't want to pay it," Prissi said. "She did everything right, and there was just a mix-up, and in this case I knew this was a bill she wouldn't have to pay."

Kenya's not alone. Sigell reported finding case after case locally where advocates had stepped in and won: A Woodland Hills cancer patient, whose $24,000 bill was cut to $5,000. A Moorpark woman who visited the ER for a throat infection, and had her bill slashed from $8,500 to $2,300. And an Orange County cancer patient with a bill of $185,000. She got it slashed to nothing, not even a co-pay.

"When you come to a patient advocate, they listen to your story, and if they're good they are going to dig and dig and dig, and fight for you," Prissi said.

One study says eight out of 10 hospital bills have medical errors, Sigell reported, and even regular doctor and lab bills can be confusing. Prissi says if you feel you're right, don't give up.

"I don't look that people are taken advantage of, I think healthcare is difficult," she said.

Advocates charge by the hour anywhere from $70 to $150, but for Kenya, hiring Prissi was the best decision. It took eight hours for Prissi to handle Kenya's claim after Kenya had tried for weeks.

"In the end I paid $1,200, not $24,000," she said.

"I got them to pay what they had paid in the past because they recognized it was their error and they took responsibility for it, which was the right thing," Prissi said.

Kenya is in remission with her RA, with no stress about her medical bills now. Her free time isn't spent handling anything but her little one. She wants people to know there is help out there.

There are national associations to help you find an advocate, and all the advocates who contributed to this story have signed a code of ethics. Prissi says interview advocates, consults can be free. Look for experience with cases like yours, references, hourly rate, and some may be able to give you an estimate on how long a case will take.

Although there are no guarantees, Prissi says advocates do their best to take cases they believe they can make a difference in. So far she has been successful in all the cases she's taken, getting some or all of a patient's money back. Still, she says, there is so much more that an advocate does than billing, from finding you the right health plan, advocating for an elderly parent, healthcare planning, even fighting to get you a specialist or surgeon who might be out of your network. She says find someone who specializes in your needs.

Prissi Cohen of ProPatient Advocacy (http://www.propatientadvocacy.com/).

Prissi and all of the advocates we talked with are part of the National Association of Healthcare Advocacy Consultants. All advocates sign a code of ethics (http://nahac.memberlodge.com). To find an advocate by ZIP code (http://nahac.memberlodge.com/directory?&tab=1)

Advoconnection (http://Advoconnection.com)

State and nonprofit advocacy: California Department of Managed Care (http://www.dmhc.ca.gov/)

Patient Advocate Foundation (http://www.patientadvocate.org/)

Other advocates who contributed to this story: Lisa Berry Blackstock (http://soulsherpa.net), David Sandhu (http://socalhealthadvocates.com/)