Who Pays for a Patient Advocate?

You’ve determined that you need a patient advocate, but now comes the question no one wants to ask: "How much will this cost?" If you have Medicare or Medicare Advantage, the answer is simple. You can pay nothing.

For decades, professional patient advocates charged hundreds of dollars per hour, putting their expertise out of reach for the very patients who needed it most. Most people still assume advocacy is an expensive, out-of-pocket service only wealthy patients can afford.

But that's no longer true. Solace advocacy services are completely covered by Medicare and most Medicare Advantage plans—meaning you pay absolutely nothing for professional healthcare navigation and support.

We're going to break down exactly who pays for different types of patient advocates and show you how to access the professional advocacy support you need at zero cost.

Most Patient Advocates Used to Be Expensive

Traditional Private Advocates: $100-$500 Per Hour

For decades, independent patient advocates operated in a cash-only market where hourly rates put professional healthcare navigation out of reach for most families. In major cities, experienced advocates charge $300-$500 per hour, with even basic cases easily reaching thousands of dollars.

Here's what these services typically cost:

• Initial consultation: $225-$650
• Insurance appeal assistance: $600-$1,500
• Hospital discharge planning: $800-$2,000
• Complex cancer case coordination: $5,000-$15,000 or more

These advocates work independently, have specialized healthcare expertise, and provide highly personalized service. Many are former nurses, social workers, or healthcare administrators who understand the system inside and out. But the cash-pay model meant only affluent patients could access their help when navigating serious illnesses or complex care.

This created a cruel irony—patients with the most complex medical needs, who often face financial strain from medical costs, couldn't afford the advocacy support that could help them navigate the system more effectively.

"I knew I needed help managing my care between three different specialists after my stroke, but $300 an hour was impossible on my fixed income," explains Martha, a Medicare beneficiary with diabetes and heart disease. "I was drowning in appointments and paperwork, but I thought advocacy was something I just couldn't afford."

Martha's experience reflects the reality for millions of Americans who needed professional healthcare navigation but were priced out of the market. The expertise existed, but the payment model made it inaccessible to those who could benefit most.

Hospital Advocates: Free But Limited

What Hospitals Provide

Every major hospital has patient advocates on staff who help at no charge to patients. They're funded through hospital operating budgets as part of patient satisfaction and risk management efforts, meaning you'll never receive a bill for their services.

Hospital advocates can help with:

• Resolving billing questions within that hospital system
• Assisting with discharge planning
• Addressing immediate care concerns during your stay
• Connecting you with hospital financial assistance programs
• Facilitating communication between you and your care team

The Limitations You Need to Know

While hospital advocates provide valuable support, their scope is inherently limited by their employment situation:

They only help within their hospital system. A hospital advocate can't coordinate with your outside specialists or help you navigate care at other facilities. Once you're discharged, their support typically ends.

They can't advocate against their employer. If your dispute is with the hospital's policies, billing practices, or quality of care, hospital advocates face a fundamental conflict of interest. They work for the institution, not exclusively for you.

They handle hundreds of patients simultaneously. Hospital advocates typically manage large caseloads, limiting the time and attention they can dedicate to your individual situation.

No ongoing relationship. Hospital advocacy is episodic—focused on your current admission rather than building a long-term relationship that spans your entire healthcare journey.

Hospital advocates are helpful for immediate issues during a hospital stay, but they're not designed for the ongoing care coordination that patients with chronic conditions often need.

Insurance Company Advocates: Covered But Conflicted

Case Managers vs. True Advocates

Most major insurers provide case management services they sometimes call "advocacy," typically at no cost to members with complex conditions. These programs have expanded significantly in recent years as insurers recognize the value of helping patients navigate care more efficiently.

Examples of insurance-sponsored programs include:

• UnitedHealthcare Medicare navigators
• Aetna's case management for chronic conditions
• Anthem's health advocacy services
• Kaiser Permanente's care coordination teams

These programs typically provide:

• Help understanding your benefits and coverage
• Assistance with prior authorizations and insurance requirements
• Care coordination for major illnesses
• Connection to in-network providers and services

The Fundamental Conflict

Here's what you need to understand: these "advocates" work for your insurance company, not for you. Their primary goal is managing costs and keeping care within the insurer's preferred network and guidelines.

This creates situations where their recommendations may not align with your best interests. They'll help you navigate their system efficiently, but they won't aggressively fight claim denials if it means higher costs for the insurer. They won't help you access out-of-network care that might be better for your condition but more expensive for your plan.

Insurance-sponsored advocacy can be valuable for basic navigation of your benefits and accessing in-network care. Just understand the inherent limitations when your interests conflict with the insurer's cost-saving goals.

How Solace Makes Professional Advocacy Accessible

Medicare Now Covers Professional Patient Advocacy

In 2024, Medicare introduced new billing codes that allow qualified patient advocacy services to be covered—meaning eligible patients pay nothing out of pocket. This represents the most significant expansion of healthcare advocacy access in decades.

For the first time, Medicare and Medicare Advantage patients can access professional-level advocacy without the $100-$500 hourly fees that previously made these services unaffordable. The coverage focuses on medically necessary advocacy—help managing chronic conditions, coordinating between providers, and ensuring you receive appropriate care.

Solace Bills Medicare Directly

Most independent advocates couldn't take advantage of Medicare's new coverage because they lacked the infrastructure to bill Medicare directly. That's where Solace broke new ground.

Unlike traditional private advocates who require cash payment, Solace built the complex infrastructure needed to bill Medicare directly for covered advocacy services. This breakthrough eliminates the primary barrier that kept professional advocacy out of reach for most patients.

Who qualifies for covered Solace advocacy:

• Medicare and Medicare Advantage patients
• Particularly those with serious diagnoses like cancer, heart disease, or stroke
• Patients managing multiple chronic conditions requiring specialist coordination
• Those experiencing complex care transitions between hospitals and rehabilitation
• Patients fighting insurance battles or prior authorization denials

What you get at no cost:

• Professional healthcare advocates who are experienced nurses, social workers, and clinical professionals—not customer service representatives
• A dedicated advocate who stays with you throughout your healthcare journey, learning your complete medical picture
• Virtual appointment attendance where your advocate joins doctor visits to ensure your questions get answered and important information isn't missed
• Insurance appeal assistance with a proven 54% success rate overturning denied claims
• Care coordination between all your specialists and providers, ensuring everyone is on the same page
• Medical record organization and documentation management so nothing falls through the cracks

How the Process Works

Getting started with Solace is designed to be simple, with Medicare handling the payment behind the scenes.

Coverage verification: Solace checks your specific Medicare or Medicare Advantage plan to confirm what services are covered at no cost to you.

Physician consultation: Medicare requires a brief consultation with a Solace physician to assess your needs and match you with the right advocate. This consultation is covered under your Medicare benefits.

Advocate matching: Based on your conditions and needs, you're paired with a healthcare professional who has relevant experience—a former oncology nurse if you're fighting cancer, or a specialist in cardiac care if you're managing heart disease.

Ongoing support: Your advocate works with you for as long as needed, with Medicare covering the costs according to established billing codes. There are no session limits or arbitrary cutoffs.

Why This Matters for Medicare Patients

The biggest obstacle to accessing patient advocacy has always been cost. By eliminating that barrier for Medicare patients, Solace has democratized access to professional healthcare navigation.

Medicare beneficiaries often have the most complex healthcare needs—multiple chronic conditions, frequent specialist appointments, and complicated medication regimens. These are exactly the patients who benefit most from professional advocacy, and now they can access it without financial strain.

Understanding Your Coverage Options

Medicare and Medicare Advantage Patients

If you have Original Medicare, Solace advocacy services are covered under specific circumstances, particularly for chronic care management and care coordination. The coverage applies when advocacy helps manage your medical conditions and prevents complications.

If you have Medicare Advantage, many plans include enhanced advocacy benefits as supplemental services. Solace works with numerous Medicare Advantage plans to provide covered services, often with broader coverage than Original Medicare.

How to find out your coverage: Contact Solace directly to verify your specific situation. They can check your plan details and let you know exactly what services are covered at no cost to you. This verification process typically takes 1-2 business days.

What's Still Not Covered

It's important to understand that not every type of advocacy is covered by Medicare. Services that typically require out-of-pocket payment include:

• Legal advocacy for medical malpractice issues
• Purely financial advocacy unrelated to medical care
• Cosmetic or elective procedure navigation
• Services not deemed medically necessary by Medicare guidelines

The coverage focuses on advocacy that directly supports your medical care and health outcomes—exactly the services most patients need when dealing with serious illnesses or complex conditions.

Questions to Ask About Coverage

Before choosing any advocate, make sure you understand the financial arrangement:

• "Is this service covered by my Medicare plan?"
• "Will I receive any bills for these services?"
• "What exactly is included in my covered benefits?"
• "Who do I contact if I have questions about coverage?"

Red flags to avoid: Be wary of any advocate who asks for upfront payment without first checking your Medicare coverage, or who can't clearly explain what's covered versus what isn't. Legitimate Medicare-billing advocates should be transparent about coverage and costs.

Making the Right Choice for Your Situation

When Solace Advocacy Makes Sense

You're an ideal candidate for Solace if you:

• Have Medicare or Medicare Advantage
• Are managing multiple chronic conditions that require coordination between specialists
• Feel overwhelmed by specialist appointments and treatment plans
• Are fighting insurance denials or prior authorization issues
• Need help during major care transitions like hospital discharge or starting new treatments

The advantage of covered advocacy is clear: getting professional-level support without financial stress allows you to focus entirely on your health and recovery.

When You Might Consider Private-Pay Options

Private advocates might still be worth the cost if:

• You don't have Medicare coverage and your other insurance doesn't cover advocacy
• Your needs fall outside Medicare's covered services
• You want to choose a specific advocate with highly specialized expertise in a rare condition
• You're dealing with legal issues that require attorney involvement rather than healthcare advocacy

Even when paying out-of-pocket, a skilled advocate can often save you money by overturning insurance denials, finding financial assistance programs, or preventing costly medical errors that result from poor care coordination.

Healthcare Advocacy Is No Longer a Luxury

Medicare coverage has fundamentally changed who can access professional patient advocacy. What was once a luxury service available only to wealthy patients is now accessible to millions of Medicare beneficiaries at no cost.

This transformation matters because navigating healthcare shouldn't be something you have to figure out on your own, especially when you're dealing with serious illness or a chronic condition. You deserve someone in your corner who understands the system, knows how to cut through confusion, and will fight for the care you need.

The question isn't whether you can afford advocacy—it's whether you can afford to navigate complex healthcare alone. If you have Medicare and are managing serious health conditions, professional advocacy support may be just a phone call away, covered by the benefits you've already earned.

The hardest part about getting help is often just asking for it. If you're feeling overwhelmed by your healthcare needs, take the first step and find out what advocacy services are covered under your Medicare plan. You might be surprised to discover that the professional support you need is already within reach.

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