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Insurance Consumer Advocate

Sha'Ron James

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Mailing: 200 East Gaines St.
Tallahassee, FL 32399-0308

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Insult to Injury: Tips to protect yourself and challenge a medical expense


By Matthew Pleasant, Scripps Media

Challenging a medical expense, no matter the provider, can be daunting. But there are steps you can take to protect yourself while receiving care and before you enter the hospital.

Start by familiarizing yourself with the finer points of your insurance. It may sound obvious, but Steve Burgess, the state insurance consumer advocate, said a patient failing to understand his or her own coverage leads to many of the cases he receives.

“Most people don’t know what their coverages are until they’re embroiled in a situation and then they find out very quickly,” he said. “The more you know about it, the better served you’re going to be.”

For example, advocates suggest looking closely at how your insurance charges for care provided by an in-network hospital that contracts certain employees who are out of network. You can request a hospital search for contractors within your network.

“Be firm,” said Rebecca Palm, a co-founder of CoPatient.com, a medical consumer advocacy company that specifically handles billing issues, “particularly if you’re mobile and in a situation to exercise that choice.”

Asking the right questions of hospital staff can help you avoid tests and procedures that may be unnecessary. If a doctor proposes a test, ask him or her whether the results will significantly change your treatment.

“Why would you want to go through one more procedure, one more test?” said Katalin Goencz, a co-president of Alliance of Claims Assistance Professionals, a national network of medical consumer advocates. “We are our own best advocate, and unless you ask questions, you don’t know.”

Keep a record of your own care. Important details to record are the names and number of visits you receive from doctors, the brand and amount of medications you receive and how many days you spent in an intensive care unit versus a regular room.

Those details will help you determine the accuracy of your itemized bill – a key document to uncover erroneous or unnecessary charges.

The best time to request the bill is just before discharge from a facility. And keep in mind, Palms said, hospitals shouldn’t charge you for the day you leave.

Scrutinize the bill closely. Advocates frequently catch providers charging for doctor visits that never occurred, one too many days in an intensive care unit and supplies used during a procedure that should not be billable.

“It’s like buying a car and getting charged extra for tires,” Goencz said.

Of course, some of this advice isn’t practical in an emergency. Advocates suggest enlisting the help of a friend or a relative and possibly giving one of them power of attorney to help make decisions on your behalf.


Some advocates suggest submitting any bills for a significant hospital visit for expert review. If you can’t get help through a provider or insurance appeals process, you can turn to an advocate. CoPatient.com (www.copatient.com), based in Portland, Ore., employs a team of advocates and technology that scans bills for errors. A preliminary review is free.

"We saw a gap in the market for tools and solutions for the consumer for this medical billing problem," Palms said.

Finding an advocate in Florida offers the benefit of someone familiar with state laws and regulations. You can start with the Alliance of Claims Assistance Professionals website, which allows you to search by state. (http://www.claims.org/refer.php)

Your research on advocates should go further by quizzing them on their expertise and experience.

"It’s a personal thing. You’re trusting your medical information with a stranger,” Goencz said. “You want to be comfortable that person can handle what you need.”

If you have an issue with a state-regulated insurance company, the state Department of Financial Services’ consumer division can assist.

Case workers can communicate with divisions within an insurance company beyond a customer service line, said Pam White, a senior management analyst in the division.

“It gets a fresh set of eyes on the situation,” she said.

To contact the divisions hotline, call 877-693-5236 or online through its website (http://www.myfloridacfo.com/Division/Consumers/contactus.htm).

The division also has a regional office in Largo at 11351 Ulmerton Road, Suite 314.