Medical bill advocacy vendors tend to pitch the same way: a big savings number, a short case study and a promise that HR never has to touch a bill again. The number is the least useful part. What decides whether the benefit works is in the details nobody puts on the slide.
These are the twelve questions we would ask in your position, grouped by what they test. We sell this service, so put them to us as well. Our own answers are at the end.
Quick answer
Scope: which bills, for whom
1. Which bills qualify? The bills employees struggle with most are often the ones outside the plan: a ground ambulance ride, an out of network specialist, a visit paid without insurance, a balance left after a denial. If the vendor only works claims that went through your plan, much of the problem stays where it is.
2. Is there a minimum balance or a case cap? A $2,000 minimum sounds reasonable until you notice that most employee bills are smaller. Ask what share of last year's cases, across their book, fell under $1,000.
3. Who is eligible? Dependents, part time staff, people who waived your coverage, people in their waiting period. Bills don't check enrollment status first.
The work: who does what
4. Who contacts the provider? Some services review the bill and give the employee a script or a letter to send. That is useful, but the employee still has to make the calls, and that is the part most people don't finish. Ask whether a person contacts the billing office on the employee's behalf, and how many follow ups they make before they stop.
5. What routes do they actually use? A good answer covers more than negotiation: getting the itemized bill, checking it against the EOB, hospital financial assistance, self-pay and prompt pay discounts, interest free payment plans, insurer appeals and the federal good faith estimate dispute where it applies. A vendor that only negotiates leaves the free routes on the table.
6. Who are the people and what is the software doing? Ask about training and supervision. There is a recognized credential for patient advocates, the Board Certified Patient Advocate, though many good billing specialists don't hold it. If the vendor uses AI, ask what it does and where a person checks it. Reading and flagging a bill is a reasonable job for software. Deciding what to tell a hospital is not.
Pricing and incentives
7. How is the fee structured, and what does it reward? The common models are a share of savings, a per employee per month fee, a fee per case, or a flat program fee. None is wrong, but each points the vendor somewhere. A share of savings pays most on large hospital bills and least on the $400 lab bill. A per employee fee with low use can mean you pay for a service nobody knows about. Ask the vendor to explain how their model keeps small bills worth working.
Outcomes and reporting
8. How do you measure savings? This is the question that matters most and gets the vaguest answers. Savings counted from the full billed charge, before any discount the person would have got anyway, look far bigger than savings counted from what they would really have owed. Ask for the starting point in writing, and ask whether savings to the employee are reported separately from savings to the plan.
9. What counts as resolved? Corrected, reduced, put on a payment plan, closed with no change, or abandoned when the employee stopped replying. All of those can be called resolved. Ask for the breakdown.
10. Where do your headline figures come from? Statistics like "8 in 10 medical bills contain errors" are repeated across this industry without a published method. The best rigorous evidence is more modest: in a nationally representative survey in JAMA Health Forum in 2024, about a quarter of people who contacted the billing office about a disputed or unaffordable bill had it corrected, and 15% got the price reduced. That is a good reason to challenge bills. It is not a guarantee, and a vendor that promises one should be able to show the sample behind it.
Privacy and HIPAA
11. What do we see, and how does the data flow? You should get aggregate reporting, never an individual's bills or diagnoses. Under HIPAA, a group health plan can give the employer as plan sponsor summary health information and enrollment information, and anything beyond that needs plan document amendments and a certification. If the service is provided on behalf of your group health plan and the vendor handles protected health information to do it, the vendor is generally a business associate and needs a BAA. If employees use the service directly, on their own authorization, the setup can be different. Ask the vendor to draw the data flow and check it with your benefits counsel.
The employee experience
12. What does the employee have to do, and what happens when nothing can be saved? Sending a photo of a bill should be most of the job. Ask how long until the first update, how the employee is kept informed, and what they hear when the bill turns out to be correct. A straight answer with the checking shown is a real outcome. A vendor that never reports one is either very lucky or not telling you.
If you want the context for why these questions matter more as deductibles rise, our piece on the bills employees pay covers it, and our comparison of bill advocacy, navigation and EAPs helps you check whether you already have this covered.
How mediloop answers these
- Scope: insured and uninsured bills, including bills outside the plan. Eligibility and supported case types are agreed with you before launch.
- The work: our AI reads the bill and flags what looks wrong. A mediloop specialist checks it, decides the route and is the only one who contacts the provider.
- Pricing: agreed per partnership, based on the eligible population and a case allowance. There is no published rate.
- Outcomes: the reporting definition is agreed before launch, and we report what the employee owed before and after separately from anything to do with plan spend. We make no claim to reduce premiums.
- Privacy: employees submit their own bills and authorization through our intake. You get aggregate reporting, not case details.
- No savings: some bills are right. When they are, we say so and show what we checked.
More on how a pilot is scoped is on the employer page and, if you advise employers, on the broker page.
Sources
- HHS, Business associates
A business associate performs functions involving protected health information on behalf of a covered entity, including claims processing or administration, data analysis and billing. Examples include a third party administrator assisting a health plan with claims. The business associate contract must limit how the associate uses and discloses the information.
- eCFR, 45 CFR 164.504(f), group health plan disclosures to the plan sponsor
A group health plan may give the plan sponsor summary health information (for premium bids or amending the plan) and enrollment information. Disclosing other protected health information requires plan documents that restrict the sponsor's use and a certification from the sponsor.
- Duffy, Frasco and Trish, JAMA Health Forum, August 2024
Of adults who received a bill they disputed or could not afford, 61.5% contacted the billing office; among those, 25.7% had the bill corrected, 15.2% got a price reduction and 8.1% got financial assistance. Nationally representative survey of 1,135 adults, 2023.
- Patient Advocate Certification Board, BCPA eligibility
To sit the Board Certified Patient Advocate exam a candidate needs two letters of recommendation, a self-assessment, and either a bachelor's degree or documented equivalent advocacy experience.
Sources last checked 25 October 2026. Medical billing rules change, so if you spot something out of date, tell us and we will correct it.
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