Advocacy and Appeals for Chronic Illness Patients: How to Lower Medical Costs
When “Denied” Turns Into “Approved”
When her insurer denied a medically necessary surgery, Rachel Green thought she had reached a dead end. Instead of giving up, she contacted the Patient Advocate Foundation, a national nonprofit that provides free case management and appeals support. A case manager reviewed her Explanation of Benefits, gathered clinical records, and cited coverage statutes in a formal appeal. Three weeks later, the insurer reversed its decision and approved the procedure.
Her experience reflects the organization’s broader impact. In 2023, the Patient Advocate Foundation helped patients recover more than twenty six million dollars in overturned or newly paid claims.
During 2025, while recording The Power of the Patient Series, Sally spoke candidly about her early experiences with appeals. At the time, she had just completed her first successful challenge of a coverage denial and was learning how nonprofit guidance could shift the balance of power for patients.
Before sharing her insight, she explained how she discovered tools like appeal templates and nonprofit legal guides while searching for help. She had been reading insurance documents line by line, learning how modifiers and clauses were used and comparing her plan’s wording to state and federal rules:
“Go to Breakthrough1d.org, they have appeal templates and nonprofit programs that help you fight coverage denials. You are not begging, you are using your rights.”
— Sally Figueroa
In another discussion recorded that year, she described the moment she challenged a denial directly. After quoting her plan’s criteria back to the insurer, the tone of the call changed, and so did the outcome. As she recalled:
“The first time I appealed a denial, I was terrified. But once I quoted their own policy back to them, everything changed. It is not about arguing, it is about being informed.”
— Sally Figueroa
Her experience aligns with nonprofit guidance emphasizing that written appeals referencing plan language and medical necessity often overturn initial denials. Knowledge, not confrontation, is what shifts outcomes.
Talking Down the Bill
After a sudden hospitalization, Detroit resident Luis Martinez received a nine thousand dollar bill. Rather than entering a payment plan he could not sustain, he contacted Dollar For, a nonprofit that enforces hospital charity care requirements. A volunteer explained the hospital’s financial assistance policy and helped him prepare to negotiate. They practiced one sentence together:
“I cannot pay nine. I can pay three.”
Anchoring the negotiation to his income and the hospital’s own rules reduced his bill from nine thousand to three thousand dollars. Dollar For has helped eliminate more than twenty five million dollars in medical debt since 2020.
In 2024, Sally reflected on how negotiating medical costs had become a turning point in her own care. She had recently pushed for an imaging test that clinicians initially dismissed, and documenting her symptoms helped her advocate effectively. Her takeaway from that season was strong and direct:
“I just feel very strongly about being your own health advocate. I pushed to get the right test and it made all the difference. You have to ask, question, and keep at it.”
— Sally Figueroa
Weeks later, while discussing medical budgeting, she expanded on why cost conversations matter:
“When you learn to talk money with medical offices the way they talk medicine, everything shifts. You are not a bad patient for asking what something costs.”
— Sally Figueroa
Negotiation is not confrontation. It is understanding a system well enough to stand inside it with confidence.
Scripts That Work
Nonprofits that support medical billing reform consistently highlight a few questions that improve accuracy, uncover errors, or open the door to financial assistance.
- “Can you review this charge? FAIR Health shows the typical local rate is ___.”
FAIR Health’s cost lookup tool gives patients regional averages for CPT codes. - “Is there a financial assistance policy for this hospital? Could I apply?”
Nonprofit hospitals must provide these programs under federal law. - “If I pay in full today, is there a prompt pay discount?”
Clinics frequently offer immediate payment reductions of ten to thirty percent.
Guidance from the Consumer Financial Protection Bureau reinforces the importance of requesting itemized bills, checking codes, and requesting corrections before paying.
During the development of the Navigating Healthcare Series, Sally shared a system she built during a period of frequent contact with insurers and billing offices. She kept a simple log with names, dates, times, and summaries to track accountability and reduce miscommunication:
“Keep a notes app or a paper log. Every time you call insurance or billing, write the name and time. When you reference that back, they treat you differently because they know you are tracking.”
— Sally Figueroa
Documentation becomes a financial safety tool and often changes the tone of the conversation.
Systemic Shifts
Individual advocacy has begun reshaping healthcare systems. After investigative reporting revealed that nonprofit hospitals in North Carolina were suing low income patients, public pressure mounted. Ultimately, Advocate Health canceled more than eleven thousand medical debt judgments.
Consumer protection organizations also document how charity care rules, billing protections, and income based assistance vary by state and how transparency is pushing hospitals to comply more fully with federal requirements.
“When patients share their stories, it stops being a you problem and becomes a we problem. That is how systems change, one call, one letter, one voice at a time.”
— Sally Figueroa
Later, she added:
“Sometimes the win is not just your own bill. It is making sure the next person does not have to fight as hard.”
— Sally Figueroa
Our Pay It Forward Approach
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Verification Note
All links opened and verified active December 2025.
All sources are nonprofit, government, or peer-reviewed / policy institutions directly supporting statements in this article.
Patient Advocate Foundation — https://www.patientadvocate.org/about/news/2024-impact-report/
JDRF — https://www.jdrf.org/t1d-resources/insurance/
Kaiser Family Foundation — https://www.kff.org/health-reform/issue-brief/how-to-appeal-an-insurance-denial/
Dollar For — https://dollarfor.org/impact
FAIR Health Consumer — https://www.fairhealthconsumer.org/
Consumer Financial Protection Bureau — https://www.consumerfinance.gov/consumer-tools/medical-bills/
KFF Health News — https://kffhealthnews.org/news/article/nonprofit-hospitals-lawsuits-patient-medical-debt/
National Consumer Law Center — https://www.nclc.org/issues/medical-debt-charity-care/