What Is a Health Advocate and How Can They Help You? (Updated November 2025)

Picture this: You just got a cancer diagnosis. Your doctor rattled off terms you didn't understand, handed you referrals to three different specialists, and said someone from the office would call about scheduling. A week later, you're still waiting for that call. You've left messages at two specialist offices that haven't called back. Your insurance company says you need something called a "prior authorization" before they'll cover the PET scan. And you still don't fully understand what stage cancer you have or what your treatment options are.

This is the U.S. healthcare system. It's massive, confusing, exhausting, and—let's be honest—it wasn't built for patients. It's designed to wear you down with administrative hurdles, scattered information, and endless phone trees. When you're already dealing with a health crisis, the last thing you need is to become a full-time healthcare administrator.

All patients deserve a dedicated expert who cuts through the confusion, fights for their care, and stays by their side. That expert is a health advocate. In this article, we'll explain what health advocates do, when you need one, how they improve health outcomes, and how to find the right advocate for your situation.

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What Is a Health Advocate?

A health advocate (also known as a patient advocate) is a professional who helps you manage everything about your healthcare journey. They serve as a bridge between you and the healthcare system, making sure your needs are communicated, your questions are answered, and you understand your options at every step.

Health advocates typically come from healthcare backgrounds—they're nurses, social workers, case managers, and clinical researchers. They know the system because they've worked inside it. They speak the language of insurance companies and medical offices. They understand what questions to ask and how to get things done.

Here's what makes professional advocates different from well-meaning family and friends: They work FOR you, not for insurance companies or hospitals. They have the expertise to navigate complex medical and insurance issues. And they're available during business hours to make the calls and push for answers when you can't.

At Solace, we take this a step further. When you become a patient, you're matched with one dedicated advocate who learns your full story and stays with you throughout your entire healthcare journey. No bouncing around between different people. No repeating your story over and over. Just one real person who never stops showing up.

The Healthcare System Problem: Why You Need an Advocate

The U.S. healthcare system is one of the most complex in the world. Administrative costs alone make up 8% of all healthcare spending—surpassing other developed countries by at least five percentage points. All that complexity creates three major problems that directly harm patients:

Communication breakdowns between providers. Your cardiologist doesn't know what your endocrinologist prescribed. Your primary care doctor hasn't received your hospital discharge summary. Your physical therapist isn't aware of your new mobility limitations. When providers don't communicate, you end up with conflicting instructions, dangerous medication interactions, and fragmented care that doesn't address your actual needs.

Care transitions where most mistakes happen. The most dangerous moments in healthcare are when you move between settings—hospital to rehabilitation center, rehab to home, one specialist to another. Critical information gets lost. Instructions contradict each other. No one takes responsibility for making sure you understand what happens next. These transitions are where people fall through the cracks.

Insurance barriers that delay or deny care. You need a medication your doctor prescribed, but insurance denies it. You need to see a specialist, but you're stuck waiting for prior authorization that takes weeks. You receive a confusing bill for a service you thought was covered. The insurance bureaucracy isn't designed to help you—it's designed to manage costs, often at the expense of your care.

These aren't occasional glitches. They're features of how the system operates. And they create situations where you need an advocate:

You're managing a chronic illness and coordinating care between multiple specialists who never talk to each other. You've just received a complex diagnosis like cancer or heart disease and don't know where to start. Your insurance denied a claim or you're facing a massive medical bill you can't understand. You're helping an aging parent who needs support coordinating appointments and medications. You're being discharged from the hospital and the instructions are confusing or incomplete. You're transitioning between care facilities and worried about information getting lost.

In any of these situations, an advocate provides the stability and clarity the system doesn't.

What Does a Health Advocate Actually Do?

Health advocates handle the details that bog down patients. They make the calls, organize the paperwork, ask the right questions, and ensure nothing falls through the cracks. Here's what that looks like in practice:

Appointment Support

Your advocate prepares key questions before appointments to make sure nothing important gets overlooked. They attend your medical appointments virtually—taking notes, asking clarifying questions, and ensuring all your concerns are addressed properly. They keep appointments focused so doctors address your most important health concerns instead of running out of time. After appointments, they review notes with you, explain next steps, and schedule necessary follow-ups to maintain continuity of care.

Research shows that having another person present during medical appointments helps patients better understand their diagnosis and treatment options. When there are two people on the same page, you don't have to agonize about making all the decisions alone.

Communication and Coordination

Perhaps the most valuable thing advocates do is serve as your single point of contact across your entire healthcare team. They communicate with doctors on your behalf to ensure your medical needs are understood. They facilitate communication between multiple specialists to prevent gaps in care coordination. They keep family members and caregivers updated on care plans and medical status. And they translate complex medical language into plain, understandable terms.

This coordination prevents the dangerous miscommunications that lead to medical errors. When someone is actively managing information flow between all your providers, everyone has what they need to make good decisions about your care.

Medical Records Management

Your medical records are scattered across different offices, different computer systems, and different formats. Advocates organize these records from multiple providers into a coherent, accessible format. They retrieve missing documents from various healthcare facilities to create a complete medical history. They identify and correct errors in medical records to prevent mistakes in treatment. They securely transfer records between providers during care transitions. And they track and explain new documents like test results so you understand their significance.

Insurance and Financial Navigation

This is where advocates often provide the most concrete, measurable help. They manage insurance appeals for denied claims—at Solace, our advocates have a 54% success rate for overturned decisions, which can save thousands of dollars. They navigate prior authorizations to prevent delays in necessary treatments and procedures. They identify billing errors, negotiate with providers, and secure payment plans to reduce your medical bills. They find discounts on prescriptions through patient assistance programs. And they help you secure financial aid from government programs and nonprofits.

According to research, patient advocates help ensure accuracy in medical billing and assist patients in navigating the financial aspects of their healthcare, often uncovering errors that save patients significant money.

Research and Resources

Advocates research your medical conditions using reliable sources to provide accurate information. They find appropriate specialists who have expertise in your specific condition—often securing appointments faster than you could on your own. They research treatment options to help you make informed decisions about your care. They stay current on clinical trials and emerging treatments that might benefit you. They investigate medication interactions and alternatives when side effects or concerns arise. And they connect you with local resources like support groups, transportation services, and food assistance programs.

Types of Health Advocacy

Professional health advocates often blend multiple roles to meet your specific needs. Unlike the fragmented healthcare system, good advocates don't make you choose between different types of support. But it's helpful to understand the main areas where advocates provide help:

Clinical and Medical Advocacy focuses on understanding your diagnosis, evaluating treatment options, and communicating effectively with providers. These advocates help you prepare questions for your doctor, understand what different treatments involve, and make informed decisions about your care path.

Administrative Advocacy handles the paperwork, scheduling, and organizational tasks that eat up so much time and energy. This includes managing medical records, coordinating appointments across multiple providers, and ensuring information flows smoothly through your healthcare team.

Financial and Insurance Advocacy tackles the billing and coverage issues that create enormous stress. These advocates handle claim denials, billing disputes, coverage questions, and connecting you with financial assistance programs.

Case Management provides comprehensive coordination for complex care situations. Case managers oversee every aspect of your care across multiple providers, ensuring continuity and preventing anything from falling through the cracks.

The key thing to understand: You don't need to figure out which type of advocacy you need. A good advocate assesses your situation and provides the right mix of support for your specific circumstances.

Real Benefits: What Changes When You Have an Advocate

Let's talk about what actually changes when you work with a health advocate. Not abstract promises, but concrete improvements in your healthcare experience and outcomes:

Reduced Stress and Mental Load

The administrative burden of healthcare is crushing. Between calling insurance companies, tracking down records, scheduling appointments, and trying to understand medical bills, patients spend hours each week just trying to manage the system. With an advocate, someone else handles this legwork. You're not on hold with your insurance company for 45 minutes. You're not tracking down test results that were supposed to be sent to your specialist. You're not trying to decode an explanation of benefits at 11 p.m. because it's the only quiet moment you have.

You can focus on your recovery, your treatment, your health—not on administration. That shift matters enormously, especially when you're already dealing with the physical and emotional challenges of illness.

Better Health Outcomes

Research demonstrates that health advocates improve patient outcomes by minimizing communication gaps between healthcare professionals and patients. When you have an advocate coordinating your care, you receive timely, coordinated treatment from all your providers. Communication improves, which reduces medical errors. You understand your care plan better, which leads to better treatment adherence. Care transitions happen smoothly instead of dangerously.

According to a 2019 study, 42% of physicians said health advocacy helped improve quality outcomes, 38% indicated it improved patient experiences, and 26% agreed that healthcare advocacy created cost-saving efficiencies.

When your advocate clarifies instructions, ensures continuity between providers, and helps you understand why each part of your treatment matters, you're more likely to follow through effectively. That directly translates to better health results.

Financial Relief

The financial impact of advocacy is often immediate and measurable. Successful appeals of denied claims can save thousands of dollars. Identifying billing errors reduces overcharges—and medical billing errors are remarkably common. Finding patient assistance programs and prescription discount cards cuts your out-of-pocket costs. Understanding your coverage prevents surprise bills.

Beyond direct savings, advocates help you avoid the financial stress that comes from not knowing what you'll owe or how you'll pay for necessary care. That peace of mind has real value.

Empowerment Through Knowledge

Perhaps the most important change is this: You understand what's happening with your health. You know what your diagnosis means. You understand your treatment options and the reasoning behind recommendations. You feel confident in your medical decisions because you have the information you need. Your voice is heard by all your providers. You can track your progress even when things get complicated.

According to Johns Hopkins Medicine, another set of ears can ease your healthcare journey significantly. An advocate helps doctors educate you about your condition so you can manage it better. When you're empowered with knowledge and support, you become an active participant in your care rather than a passive recipient.

How to Find a Qualified Health Advocate

Finding the right advocate for your situation requires knowing what to look for and what questions to ask. Here's how to evaluate potential advocates:

What to Look For

Start with healthcare background and relevant experience. The best advocates have worked inside the healthcare system—as nurses, social workers, case managers, or in clinical research. They understand medical terminology, insurance processes, and how healthcare organizations actually function. Ask about their specific experience with your type of situation. Someone who has helped patients navigate cancer treatment will bring different expertise than someone who specializes in elder care coordination.

Certifications can be helpful but aren't the only measure of quality. The Patient Advocate Certification Board (PACB) offers professional certification, which demonstrates commitment to the field. However, excellent advocates also come from clinical backgrounds with years of practical experience helping patients navigate the system.

Look for strong references and a track record of results. Ask potential advocates for examples of how they've helped patients in situations similar to yours. Check if they can provide references from past clients.

Questions to Ask Potential Advocates

When interviewing advocates, these questions will help you determine if they're the right fit:

What is your healthcare background, and what experience do you have with my specific condition or situation? How will we communicate, and how often can I expect to hear from you? What does your typical support process look like from start to finish? What specific services are included in your advocacy? How do you charge, and what payment options are available? Can you provide references from past clients? Are you available to attend medical appointments with me (virtually or in person)?

Pay attention not just to the answers but to how the advocate responds. Do they listen carefully to understand your situation? Do they explain things clearly without jargon? Do they seem genuinely invested in helping you, or are they just running through a script?

Red Flags to Watch For

Be cautious of advocates who have no healthcare background or relevant training. Avoid anyone who makes promises about specific outcomes—no ethical advocate can guarantee that insurance will approve a claim or that you'll get into a particular specialist. Watch out for high-pressure sales tactics or anyone who tries to rush you into a decision. And be wary of advocates who don't provide a clear fee structure or who are vague about what services are included.

Trust your instincts. If something feels off or if you don't feel heard and respected, keep looking. The right advocate will make you feel supported, not pressured.

Does Medicare or Insurance Cover Health Advocates?

Yes, health advocacy services are now covered by many insurance plans, making professional support accessible to more patients than ever before.

Original Medicare Part B covers health advocacy services as of January 2024. If you have traditional Medicare, you have access to covered advocacy support. Many Medicare Advantage plans also include advocacy services, though coverage specifics vary by plan. Some employer health plans offer advocacy benefits as part of their coverage package.

At Solace, 98% of our patients pay nothing out-of-pocket because their Medicare or insurance plan covers our services. To check if your plan covers advocacy, review your benefits documents or call the customer service number on your insurance card. Ask specifically about "patient advocacy services" or "healthcare navigation services." You can also contact Solace directly—we'll verify your coverage and let you know exactly what your plan includes.

Even if your plan doesn't cover advocacy services, many patients find the support worth the cost given the time savings, stress reduction, and financial benefits advocates provide. Some advocates offer flexible payment options, including hourly rates or package pricing for specific services.

For more details about how Medicare coverage works for advocacy services, read our complete guide: How Solace Advocacy is Covered by Medicare.

How Health Advocates Improve Outcomes: The Evidence

The benefits of health advocacy aren't just anecdotal—there's substantial evidence that advocates make a measurable difference in patient outcomes and healthcare quality.

Reducing Medical Errors

According to the Agency for Healthcare Research and Quality, health advocates help patients better understand their illness and get the care and resources they need. By clarifying instructions and improving communication between patients and providers, advocates help prevent the misunderstandings that can lead to medication errors, missed follow-ups, and incorrect treatments.

Ensuring Continuity of Care

Advocates coordinate appointments and treatments to avoid lapses in care, particularly critical for patients seeing multiple providers. Research shows that advocates help coordinate logistical details and ensure continuity across healthcare teams. This coordination is especially important during care transitions—the handoffs between hospital and home, between specialists, or between facilities—where most medical errors occur.

Improving Treatment Adherence

When patients understand their treatment plan and feel supported in following it, they're more likely to stick with their care regimen. Studies indicate that by helping patients and caregivers understand treatment plans and the importance of adhering to them, advocates promote better compliance. This adherence is crucial for managing chronic conditions, achieving better health outcomes, and preventing complications.

Providing Emotional Support

An advocate's presence can reduce patient anxiety, leading to better adherence to treatments and improved recovery. Research demonstrates that having consistent support throughout the healthcare journey helps patients feel less overwhelmed and more confident in their care decisions. This emotional stability contributes directly to better physical health outcomes.

Reducing Healthcare Costs

A 2020 study found that integrating health advocacy into health plans improved outcomes and lowered costs. Advocates help patients avoid unnecessary emergency room visits, reduce hospital readmissions through better care coordination, and prevent complications through proper treatment adherence—all of which reduce overall healthcare spending while improving patient health.

What Makes Professional Advocacy Different

Many patients start by having a family member or friend try to help navigate the healthcare system. This support is valuable and important—having someone who cares about you by your side matters enormously. But professional advocates bring something different to the table.

Professional advocates have healthcare system expertise that comes from working inside hospitals, insurance companies, or clinical settings. They understand how the system actually operates, not just how it's supposed to work. They know medical terminology and can translate between the technical language doctors use and the plain English you need to make decisions. They understand insurance processes—what triggers a denial, how to appeal effectively, what documentation matters.

Professional advocates bring emotional distance that allows for objective decision-making. When you're scared or overwhelmed, or when a family member is emotionally invested in a particular outcome, that can cloud judgment. A professional advocate can assess the situation clearly and help you weigh options without the emotional weight that comes from being the patient or a close family member.

They're available during business hours to make the calls that matter. Most people can't take time off work every day to sit on hold with insurance companies or call doctor's offices during their limited calling hours. Professional advocates do this as their job, which means they can be persistent and follow up in ways that working adults often can't.

Perhaps most importantly, professional advocates provide dedicated focus on your case. They're not trying to juggle your medical needs alongside their own work, family, and life responsibilities. Your care is their priority.

This doesn't mean professional advocates replace family support. In fact, the best outcomes often happen when professional advocates work alongside family members and caregivers. The professional handles system navigation while family provides emotional support, companionship, and day-to-day care. Together, this combination gives patients comprehensive support that addresses every aspect of their healthcare journey.

How a Solace Advocate Can Help

All patients deserve a dedicated expert who cuts through the confusion, fights for their care, and stays by their side. At Solace, that's exactly what we provide.

When you become a Solace patient, you're matched with one dedicated advocate from our team who stays with you throughout your entire healthcare journey. No bouncing around between different representatives. No repeating your story over and over. Just one real person who learns everything about your situation and never stops showing up for you.

Our advocates are real healthcare professionals—nurses, social workers, case managers, and clinical researchers—who know the system because they've worked inside it. They bring that expertise to work for you, not for insurance companies or hospitals. They speak the language of medical offices and insurance bureaucracies, which means they know how to get things done.

We start by truly listening. Before we do anything else, your advocate takes time to understand your full story. What are you dealing with? What's overwhelming you? What do you need most right now? We don't operate from scripts or one-size-fits-all approaches. We build a relationship based on understanding your specific situation and needs.

We handle the legwork so you don't have to. You won't spend hours on hold with insurance companies. You won't chase down medical records or try to decode confusing bills. You won't lie awake at night wondering if you asked the right questions at your appointment. Your advocate handles all of this. We make the calls, send the faxes, track down the documents, and push for answers until we get them.

We attend your appointments virtually. Your advocate joins your medical appointments remotely, which means you're never alone in important conversations with doctors. We prepare key questions beforehand to make sure nothing gets overlooked. During the appointment, we take detailed notes, ask for clarification when something's unclear, and ensure all your concerns are addressed. After the appointment, we review everything with you and handle follow-up tasks.

We coordinate between all your providers. One of the most valuable things we do is serve as your single point of contact across your entire healthcare team. We communicate with each of your doctors to ensure everyone is on the same page. We facilitate information sharing between specialists. We catch conflicting instructions before they cause problems. We keep track of everything so nothing falls through the cracks.

We fight insurance denials and navigate coverage. When insurance denies a claim, we appeal—and we have a 54% success rate for overturned decisions. We handle prior authorizations to prevent delays in necessary treatments. We identify billing errors and negotiate with providers to reduce your costs. We find patient assistance programs and prescription discounts to lower your out-of-pocket expenses.

We organize your medical records. We gather records from all your providers and organize them into a clear, accessible format. We identify and correct errors. We ensure records are transferred accurately during care transitions. We track new documents like test results and explain what they mean for your care.

We find the right specialists. When you need to see a specialist, we research options, check qualifications and availability, and often secure appointments faster than you could on your own. We make sure the specialist is in your network and has experience with your specific condition.

We connect you with resources. Beyond medical care, we help you access community resources like support groups, transportation services, food assistance programs, and financial aid. We apply for assistance programs on your behalf and coordinate all these resources with your medical care to support your overall wellbeing.

The results speak for themselves: 98% of Solace patients report better healthcare outcomes after working with an advocate. Our services are covered by Original Medicare and many Medicare Advantage plans, which means most of our patients pay nothing out-of-pocket.

When you're a Solace patient, you finally have someone who knows what to do next—and who never stops showing up. You have a plan. You understand your care. You're not alone. And you can focus on what matters most: your health and recovery.

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Frequently Asked Questions about Health Advocates

What exactly does a health advocate do day-to-day?

A health advocate handles the details that bog down patients: making calls to insurance companies, scheduling appointments, organizing records, researching treatment options, and ensuring all your providers communicate. When you work with a Solace advocate, they attend your appointments virtually, prepare questions beforehand, take notes during visits, and follow up on next steps. They work behind the scenes so you can focus on your health. The specific tasks vary based on what you need most—some days your advocate might be appealing an insurance denial, other days they're coordinating between your cardiologist and your primary care doctor, and other days they're helping you understand new test results.

How much does hiring a health advocate cost?

Professional health advocacy is now covered by Original Medicare Part B and many Medicare Advantage plans. At Solace, 98% of patients pay nothing out-of-pocket because their insurance covers our services. If you don't have coverage through Medicare or your insurance plan, costs vary depending on the services you need. Some advocates charge hourly rates ranging from $75 to $250 per hour, while others offer package pricing for specific services like insurance appeals or care coordination. Many patients find that even when paying out-of-pocket, advocates save them more money through successful appeals and billing error correction than the advocacy services cost.

Can a family member serve as my health advocate instead of hiring someone?

Family members can absolutely advocate for you, and many do. Having someone who loves you by your side during medical appointments and helping make decisions is incredibly valuable. However, professional advocates bring healthcare system expertise, medical terminology knowledge, and insurance process understanding that most family members don't have. They're also available during business hours to make necessary calls and can provide emotional distance for objective decision-making. Many families find the best approach is having both—a professional advocate handling system navigation while family provides emotional support and day-to-day care assistance. Professional advocates often work directly with family members, providing them with additional support and resources.

How do I know if I need a health advocate?

You might benefit from an advocate if you're managing a chronic condition that requires coordinating care between multiple specialists, facing insurance denials or confusing medical bills, transitioning between care settings like hospital to rehabilitation or rehab to home, helping an aging parent navigate healthcare needs, or simply feeling overwhelmed by the healthcare system. If you're spending hours on hold with insurance companies, repeating your story to different providers who never seem to communicate with each other, or unsure what questions to ask your doctor, an advocate can help. The system shouldn't require you to be a full-time healthcare administrator on top of dealing with illness—that's when advocacy makes the biggest difference.

Will my health advocate have access to my medical records?

Only with your explicit written permission. Professional health advocates follow strict confidentiality guidelines and HIPAA regulations. You control exactly what information they can access and which providers they can contact on your behalf. At Solace, advocates work within the permissions you set and maintain complete privacy of your health information. Most patients choose to give their advocate access to medical records so they can coordinate care effectively, organize documents, and identify important information. But the decision is entirely yours, and you can adjust permissions at any time based on your comfort level and needs.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.

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Related Reading:

• What Are Patient Advocates, And How Do They Help?
• How To Get A Patient Advocate
• Does Insurance Cover Patient Advocates?
• ‍Open Enrollment and Patient Advocates: What You Need To Know
• What Is A Health Insurance Advocate and How Can Help Help You?

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