Last updated November 2026
A few years ago, Michael Hinton, 58, found himself facing both a serious health challenge and a dilemma about a daunting medical bill.
Should he pay, out-of-pocket, close to $25,000 for an experimental surgery that might solve his long-standing digestive problem, or just continue to live with his sometimes-debilitating nausea and stomach pain?
“For 14 years, I bounced from one specialist to another without finding an answer,” said Hinton, who works in agribusiness technology in Kansas. “Finally, a doctor told me that experimental surgery may solve the problem. My health insurance initially refused to cover it because it was considered experimental, and the cost was significant. I wasn’t sure I could justify moving forward.”
His condition, gastroparesis, a disorder that impairs the stomach’s ability to move food normally, was disrupting both his daily life and his work. As his symptoms worsened, Hinton was nearing a breaking point.
“There were days when my symptoms became so severe that I’d have to tell our company president I needed to go home,” Hinton said. “Business travel was especially difficult because I often couldn’t eat. After meetings, I’d retreat to my hotel room just to lie down. I knew I had to find a solution before the condition impacted my ability to do my job.”
Unsure where to turn, he searched online for information about his condition, possible treatments, support services, and ways to reduce the cost of his surgery. That search led him to the Patient Advocate Foundation, a nonprofit organization that connects people with patient advocates who help navigate the healthcare system, access medical services, and manage medical costs on behalf of patients.
The foundation matched Hinton with an advocate who developed a care management plan, helped him research and prepare for his surgery, taught him how to negotiate with his hospital to reduce the surgery costs, coordinated pre- and post-surgery doctors’ appointments, and worked with his insurer to cover some of the surgery costs.
Ultimately, Hinton was able to get his $23,445 surgery bill reduced to an out-of-pocket fee of $3,175. In 2025, the foundation assisted Hinton again, helping him secure follow-up treatment at the Mayo Clinic in Minnesota. It also connected him with Angel Flight Central, which coordinated multiple charitable flights over a two-month period from Kansas, so he could access the specialized care he needed.
“Having the advocate was like having a health coach by my side throughout the entire process,” Hinton said. “They made a complex health situation manageable. I truly don’t believe I could have achieved the outcomes I did without the Patient Advocate Foundation.”
The Basics of Patient Advocacy
For patients, the U.S. healthcare system can feel like an incomprehensible maze. The average wait time to get an appointment with a physician is 31 days and climbing, and more than half of people with chronic conditions report battling their health insurer to receive coverage. Sixty-five percent of people who are dealing with a chronic health condition, or are caring for someone who does, say the time it takes to coordinate multiple appointments, manage the communication between those providers and keep track of billing for that care is overwhelming and time-consuming.
“It has never been more cumbersome to be a patient in the U.S. health system than it is now,” said Alan Klein, chief growth and strategy officer with the Patient Advocate Foundation.
Professional patient advocates can help navigate the health system labyrinth on behalf of individual patients. You can hire one of these experts to deal with health insurance and billing issues, including resolving disputes between insurers and medical providers. Some advocates specialize in supporting children of aging parents. Other pros work with patients to identify the best providers for diagnoses, treatment options, and care for their conditions. These private consultants are not to be confused with hospitals’ patient advocate offices, which help patients navigate the hospital system but ultimately work for hospitals, not patients.
The independent patient advocate profession is small but has been growing as the health system has become more complex. Since 2018, about 1,700 people have been certified by the Patient Advocate Certification Board, a nonprofit that sets standards of ethics, codes of conduct and best practices for independent patient advocates.
Generally, advocates have a professional background in healthcare, such as nursing, social work, or insurance administration. Sometimes they are former patients or their family members who decide to use what they’ve learned from personal experience to help others.
Among the tasks a private patient advocate can do for you: manage billing errors, health insurance denials, and the appeals process; find doctors, skilled nursing, and home healthcare providers; make appointments and coordinate care among providers; prepare and accompany you or a family member to medical appointments; locate clinical trials for treatments; and manage the paperwork that accompanies many healthcare services.
“Just as many people use a financial advisor or a legal advisor or life coach to manage different areas of their life,” said Elisabeth Schuler, founder and CEO of Patient Navigator. “You can also hire a private healthcare advocate with insider knowledge and direct experience in the health system to improve medical outcomes, overcome obstacles, and find resources just the way other expert advisors solve problems.”
How to Find a Patient Advocate
To find the right advocate, consider what kind of help you are looking for. Independent advocates tend to specialize in navigating a particular aspect of the health system. Some specialize in billing and insurance problems. They identify coding errors on hospital bills, write appeal letters when insurers deny payment for a treatment, and know what state and federal regulations might protect patients from abusive billing practices.
Other advocates focus on coordinating patient care for aging adults or for those with chronic health conditions requiring many appointments with specialists. These advocates can prepare questions and coordinate doctors’ visits, manage bills, track insurance explanation-of-benefits letters, or make care plans. Some advocates specialize in helping clients locate clinical trials or find the right hospitals, specialists, and options for treating their conditions.
“There is no single business model for advocates,” Schuler said. “Some advocates may only work with older adults, cancer patients, or on medical billing problems. It depends entirely on the advocate’s business, expertise, and practice set-up.”
Once you have identified what kind of advocacy you want, you can search for a pro using several websites. You may as well start by focusing on advocates who have received certification from the Patient Advocate Certification Board.
Organizations with directories and resources include:
- Aging Life Care Association
- Greater National Advocates
- HealthAdvocateX
- National Association of Healthcare Advocacy
- Patient Advocate Foundation
- Solace
- Umbra Health Advocacy
Ask prospective advocates whether they’ve handled cases like yours, their location, how they plan to communicate with you, a list of references, an estimated timeline for the work, a fee schedule, and their background and training.
“Working with an advocate is intensely personal,” said Schuler of Patient Navigator. “You must feel that you can work with that person comfortably.”
How Much Do Private Patient Advocates Cost?
Fees can range from $100 to $600 an hour, depending on where you live, the experience of the patient advocate, and the complexity of the health issue that needs navigation. Some will offer sliding scale fees, and some will offer a flat fee or a bundled rate of services to make it more affordable, said Melina Oien, deputy director of Greater National Advocates.
“All the advocates I know are really not in this because of money,” Oien said. “We have to charge because we need to pay our bills, but we’re here because we have some personal connection to this work.”
However, there are free and low-cost options for patient advocacy services.
The Patient Advocate Foundation charges nothing for its services. The organization employs about 300 full-time staff, and its case managers respond to thousands of calls and online inquiries per month, staying in touch until the issue is resolved, Klein said. He added that, on average, the foundation’s team will interact with a patient 35 times to help solve the person’s problem.
The organization’s care management teams provide patient support for financial assistance, case management, insurance assistance, and education for hundreds of diseases and conditions.
In 2026, the organization launched TotalAssist, a site where patients can obtain financial assistance to cover medication copays, insurance premiums and deductibles, treatment administration costs, and office visit charges the day of treatment for nearly 150 different disease areas. Eligibility for financial assistance is tied to an income threshold of 500 percent of the federal poverty level ($79,800 for an individual in 2026), but for anyone not eligible for financial assistance, Klein said the organization will work to help them find resources elsewhere.
“We provide resources and point people in the right direction to level the playing field for everyone trying to figure out the health system,” Klein said.
There are also hundreds of nonprofit organizations that represent patients with specific conditions that mobilize support, raise money, push policy, and represent patients, such as the American Cancer Society, ALS Association, Blood Cancer United, and National Multiple Sclerosis Society. Many of these organizations have help lines offering patient assistance for financial support for treatments and for local resources that can help a patient or their family navigate care.
Many Patient Advocacy Services Are Covered by Medicare
In January 2024, Medicare Part B began reimbursing health providers for “principal illness navigation services.” Patient advocacy falls under such navigation. To qualify, a beneficiary must be evaluated by a health provider that participates in Medicare and be diagnosed with a serious condition that is expected to last at least three months or longer, such as cancer, heart failure, or substance-use disorder. Medicare will cover 80 percent of patient navigation services if the beneficiary’s condition puts them at high risk for “hospitalization, nursing home placement, a sudden worsening of preexisting symptoms, physical or mental decline, or death.” The remainder of the advocacy fee may be covered if the patient has supplemental insurance such as Medigap.
Tallahassee, Fla., resident Dena Hall is one of those Medicare patients. In the fall of 2025, Hall found Umbra Health Advocacy, a patient advocacy company, via an internet search. Hall had been suffering for years from symptoms from fibromyalgia, a condition that causes widespread body pain, and mast cell activation syndrome, which causes pain, shortness of breath, gastrointestinal issues, and other symptoms.
“I couldn’t find a doctor who was willing to treat me in Tallahassee because my conditions were so complex and I was just getting worse and worse,” said Hall, 68. “I was in chronic, excruciating pain. I couldn’t do anything, and it was destroying my life.”
An advocate working for Umbra helped Hall find and make appointments with specialists for her conditions, including a pain management specialist, a gastrointestinal specialist, and an orthopedist. The advocate then joined Hall for many of her appointments through a video-conferencing app on Hall’s phone. The advocate coordinated the appointments and made sure all the providers were communicating with one another. Hall hasn’t paid anything for Umbra’s services.
“Amanda [Hall’s advocate] was like a bulldog,” Hall said. “She would not take no for an answer, and she would ask questions I hadn’t thought of to make sure I got the best care possible. I am now on a much better path.”
Other companies that are offering patient advocacy services for Medicare beneficiaries include Solace, Mira Mace, and DearestCare.
Why a Paid Advocate May Be Worth It
Many services provided by patient advocates aren’t covered by Medicare—for example, help with complicated insurance appeals, billing issues, or support for a medical decision for a particular condition. But the expense of hiring an advocate often still makes sense.
Many advocates focus on coordinating patient care for aging adults or family members. Many people either live too far away or have busy schedules that prevent them from managing the day-to-day needs of an aging adult, such as coordinating doctors’ visits, medications, and managing the bills.
Many advocates specialize in helping families set up geriatric long-term care management. They specialize in helping families develop a plan for dealing with a progressive health issue, and find an assisted living facility, long-term custodial care nursing home or memory care unit.
Brett Astmann, who lives in Washington, D.C., can attest to how helpful it can be to have a patient advocate on your side. Beginning in late 2022, Astmann’s 82-year-old mother Coni began to face a series of heart problems that led to repeated hospitalizations. Each time she would spend several days in the hospital, be discharged to a rehabilitation facility for a few weeks, and then sent home to her apartment at a senior living community in Arlington, Va. The situation signaled to Astmann and his brother, Chad, that his mother might need more help.
“My mom was always so active, so when her health started to worsen, we weren’t sure how it was going to progress,” Astmann said. “We weren’t sure whether she would need more support at home, to transition to assisted living, or to a nursing home, or be able to remain in her apartment with added assistance.”
Coni and her sons went to the internet and searched for answers. Their search for senior care options quickly became overwhelming.
“My brother and I are educated people, but nothing could have prepared us for the eldercare system. We didn’t know how to make sense of which options were good and which weren’t,” Astmann said. “We didn’t know how to navigate the complexities of care facilities, care levels, health aides, medication management, appointments, and transportation—it felt unmanageable.”
As the family continued to investigate options, they found themselves in a crisis. Their mother was hospitalized again, and the brothers had to quickly decide how to support her.
That’s when a family friend suggested finding a local patient advocate.
After interviewing several firms, the Astmanns hired Elder Care Consultants, a D.C.-based geriatric care management firm. An advocate from the firm met with the family and talked about living arrangements and budget.
“The advocate really engaged with my mother to find out what she wanted, which we really liked,” said Astmann.
Based on that conversation, the advocate helped the Astmanns find continuous day and evening home care. As Coni’s health continued to deteriorate, the advocate helped the family transition her to assisted living before she died in November 2024.
“The advocate gave us peace of mind that we were doing the right things for our mom during that last year and a half,” Astmann said.
“My biggest piece of advice is don’t wait for a crisis to find someone for help.”