By Pam Edmonds

I still remember those overwhelming days 20 years ago when I could barely make ends meet. As a single mother, I was confronted with the uncompromising and unexpected health challenges of my two teenage children. Along with their ongoing medical care, they both needed costly surgeries requiring hospital stays.

While I had health insurance coverage for my children, I did not realize how much of the burden would be placed on me. Bills from hospitals and health care providers mounted during those emotionally trying years. The nondescript codes on the costly bills were often difficult to understand, and it was not clear what was covered and what was not.

Rather than declare bankruptcy, I set out to become an educated health care consumer. With consistent due diligence, I began to decipher the codes on the bills and match them again the benefits in our insurance plan. I found many incorrect fees charged to our account, and embarked on an extensive appeals process to have the bills modified.

Ultimately, I had to take out several loans to pay for my children’s medical and college expenses. Eventually I had to move in with my aunt to cut costs. This was not an easy time for us, and I am certain we were not alone in our dismay of the complex health care system and the excessive fees.

I often wondered if I was an educated woman working for a life insurance company, struggling to understand the complexity of our health care billing system, how would others navigate it. Who would advocate for them? Who would conduct due diligence on their behalf to ensure they were properly charged for the actual services they received?

According to the 2016 Copatient State of Medical Bill Confusion survey:

• 72 percent of consumers have received a medical bill they didn’t understand.
• 94 percent have received a medical bill they believed was “too expensive.”
• 36 percent of consumers have received a medical bill they were unable to pay
• 41 percent had to use a payment plan
• 53 percent of consumers have tried to negotiate a medical bill
• 38 percent were successful at saving money

The 2016 Copatient survey results paint a somewhat bleak picture of the current healthcare landscape, highlighting the detrimental effects associated with a lack of consumer-facing educational tools, and the re-occurring pattern of uncertainty and discord amongst consumers, employers and health plan administrators.

Last year, I decided enough was enough. No one should go through the intimidation and fear we went through as a family. I wanted to make a difference in the lives of others by sharing what I have learned over the last two decades. I sought out training and earned the designation as one of Connecticut’s first certified patient advocates through the Patient Advocate Certification Board.

As part of my second career, I have launched Prime Patient Advocates, a consulting business designed to educate and advocate for health care consumers across New England.  In this new venture, I help individuals and families understand their confusing health care bills. I advocate from my clients with their insurance companies by reviewing bills for accuracy.