Learn About the Role of a Patient Advocate, Plus Benefits, Cost, and Insurance Coverage

We have all been there. There’s an uncertain feeling in your stomach as you open the bill from a recent surgery. You hold your breath and scan the document to find the amount due. The number is a shock, because you never understood exactly how much the surgery would cost.

That’s a normal experience and nothing you should feel bad about. Between coverage benefits, deductibles, out-of-pocket expenses, and all the other moving pieces that make up health insurance, it’s no wonder many people go into surgery not knowing how much it will cost.

Why is a patient advocate important?

In general, the word “advocate” refers to someone who helps and defends another person. That usually means that the advocate supports their partner’s cause. The advocate is their partner’s sidekick and ensures that the partner’s needs are met.

This is exactly what OSMS patient advocates do. They support patients through the confusing and ever-changing maze of health insurance benefits. OSMS advocates act on the patient’s behalf (with patient approval) and provide guidance along the way.

What are the roles and duties of a patient advocate?

The goal of each patient advocate is to support patients emotionally and educationally throughout their health care journey. Advocates help patients navigate a complex health care environment and ensure patients are equipped to make informed decisions about their care.

At OSMS, patient advocates specialize in helping patients understand insurance. After a procedure is authorized, the patient advocate will determine if any estimated out-of-pocket expenses remain after insurance benefits are applied.

For patients who will be responsible for out-of-pocket costs, the patient advocate will:

• Help the patient understand their insurance benefits
• Discuss any out-of-pocket expenses the patient will be responsible for paying
• Ensure the patient understands all the financial resources available to them
• Discuss the possibility of a down payment or other potential payment options, if needed

How do I get a patient advocate?

Patients can request to connect with an OSMS patient advocate when they schedule a surgery or infusion therapy with an OSMS physician. You can decline advocate help if you prefer—there is no pressure.

How much does a patient advocate cost?

At OSMS, access to one of our patient advocates is included in the cost of care. You can also work with an insurance company-provided advocate or a private advocate. When choosing an advocate option, consider:

• OSMS advocates have experience communicating with our providers and knowledge of our service lines (orthopedics, sports medicine, rheumatology, and pain management).
• Insurance company-provided advocates usually have their company’s best interests at heart, not yours, creating a conflict of interest.
• Private independent advocates may be costly, often charging up to $500 an hour.

Is a patient advocate the same as a proxy or power of attorney?

It’s important to note that a health care advocate is not automatically a proxy or power of attorney for health care. A health care proxy (also called a durable power of attorney for health care) is a legal document that appoints a health care agent (an individual) to make decisions on behalf of the patient if the patient becomes incapacitated.

Health care is complicated, but you’re not in this alone.

We’re here to help you understand your options, evaluate costs, and move forward with confidence. If you have questions or concerns about the cost of an upcoming or past service, get in touch by calling us at 920-430-8113. Let us know on the phone that you’d like to speak with a patient advocate.

This blog was originally published on October 30, 2018, but updated and republished on March 26, 2026.