Patient Advocates in Hospitals: What They Do and How They Help
Patient advocates serve as a bridge between patients and the healthcare system, helping navigate complex medical, administrative, and billing issues. Understanding their role can help you access this valuable resource.
What Is a Patient Advocate?
A patient advocate (also called a patient representative or ombudsman) is a professional who helps patients navigate the hospital system and ensures their rights are respected. There are several types:
Hospital Patient Advocates
- Employed by the hospital
- Address patient concerns and complaints during hospitalization
- Facilitate communication between patients and healthcare teams
- Help resolve billing and insurance issues
- Available at no additional cost to patients
Independent Patient Advocates
- Private professionals hired by patients or families
- Work solely for the patient's interests
- May charge fees for their services
- Can help with complex medical situations, second opinions, and insurance disputes
Insurance-Based Advocates
- Provided by some insurance companies
- Help navigate coverage questions and claims
- Assist with finding in-network providers
- Help with appeals and denials
What Hospital Patient Advocates Do
- Resolve complaints: Address concerns about care quality, staff behavior, facility issues
- Facilitate communication: Help patients communicate with doctors and staff, especially when there are language or cultural barriers
- Explain rights: Help patients understand their rights and hospital policies
- Navigate the system: Guide patients through hospital processes, forms, and procedures
- Address billing concerns: Help with billing questions, financial assistance applications, and insurance issues
- Ethical concerns: Help address end-of-life decisions, consent issues, and ethical dilemmas
- Discharge planning: Ensure patients understand their discharge plan and have needed resources
When to Contact a Patient Advocate
- You're not satisfied with the care you're receiving
- You feel your concerns aren't being heard by the medical team
- You need help understanding your diagnosis or treatment options
- You have billing questions or need financial assistance
- You need translation or communication support
- You want help filing a complaint or grievance
- You have questions about discharge planning
- There are disagreements about your care plan
How to Reach a Patient Advocate
- Ask your nurse or the front desk for the patient advocate's contact information
- Look for posted signs in the hospital with advocacy department information
- Call the hospital's main number and ask for patient relations
- Check the hospital's website for patient advocacy resources
Data sourced from CMS. Visit Medicare Care Compare or call 1-800-MEDICARE.
Disclaimer: This article is for informational purposes only and does not constitute medical or legal advice.
Important
This article explains how hospital quality data works and is for general information only. It is not medical advice and must not be used to decide whether to seek, delay or refuse care — that is a decision for you and a clinician who knows your situation.
CMS quality measures describe care delivered during earlier reporting periods and are refreshed roughly quarterly. A hospital's staffing, services and performance can change well before the published numbers do.
hospiguide.org is not affiliated with, endorsed by, or connected to CMS, Medicare, or any U.S. government agency, and publishes no ratings of its own.
Before acting on anything here, verify current details at Medicare.gov Care Compare or call 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.
HospiGuide.org Editorial Team
Our editorial team explains U.S. hospital quality data using official CMS datasets and government publications. We are not medical professionals, we do not recommend hospitals, and we accept no payment for coverage. Every factual claim is checked against a CMS or federal source. Read our editorial policy.
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