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What is a Health Insurance Advocate?

By D. Jeffress
Updated May 17, 2024
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A health insurance advocate is a professional who helps people identify their options for health insurance policies, file claims with insurance companies and government healthcare programs, organize records, and set up payment plans. An advocate must be very familiar with laws and regulations regarding insurance policies and medical bills, and be able to communicate effectively with patients, healthcare providers, and insurance company representatives. He or she may work for a hospital, insurance company, government organization, nonprofit group, or consulting firm. A successful, experienced health insurance advocate may also choose to become self-employed, offering his or her services to patients who have nowhere else to turn for advice.

Individuals who receive medical services often have many questions regarding their bills, payment options, and insurance plans. A skilled health insurance advocate can help patients understand their situations and make important decisions. An advocate may help an individual decide on an insurance plan and fill out the necessary paperwork to obtain it. He or she can assist a patient to establish an appropriate co-pay rate with a private company, or apply for government assistance in a program such as Medicare in the United States.

When an insurance company finds a discrepancy in a filed claim, or simply refuses to pay for a service, a health insurance advocate can step in to resolve the issue. He or she can negotiate terms with insurance representatives and hospital administrators to ensure that a patient is billed fairly for a procedure. If a patient is unable to fulfill his or her financial responsibilities, the health insurance advocate usually works hard to set up a manageable payment plan. Since so much of the job involves speaking and negotiating with others, strong communication skills are essential to successful patient advocacy.

An individual who wants to become a health insurance advocate is usually required to gain experience in occupations related to healthcare or social work. Many advocates held previous jobs as nurses, health care aides, medical billers and coders, counselors, or social workers, where they were able to learn about common issues regarding insurance and patients' needs. There are no formal degree or licensing requirements to become a health insurance advocate, though many hopeful workers pursue case manager certification to improve their credentials and likelihood of finding a job. In the United States, the Commission for Case Manager Certification offers written certifying exams to individuals who have gained experience in healthcare and patient advocacy positions.

WiseGEEK is dedicated to providing accurate and trustworthy information. We carefully select reputable sources and employ a rigorous fact-checking process to maintain the highest standards. To learn more about our commitment to accuracy, read our editorial process.

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