Behind the Bills: A Crusade For Clarity and Simplicity

In this episode of Patient Advocacy Now, we speak with Nicole Broadhurst, the founder of Tennessee Health Advocates. Nicole's practice is focused on medical billing, and she provides her clients with the tools needed to decode their healthcare charges, empowering them to take charge of their medical expenses and enhance their quality of life. Join us as Nicole Broadhurst shares her journey from a former Practice Administrator to a revered Independent Patient Advocate. Learn how she's enabling professionals to maintain work-life balance and take control of their medical expenses without the hassle of traditional billing departments.

After dedicating over two decades to the healthcare industry, Nicole Broadhurst identified a critical flaw: the system was profoundly patient-unfriendly, particularly when it came to navigating the convoluted billing process. This realization drove her to establish Tennessee Health Advocates. By mitigating the stress and confusion associated with medical bills, her organization ensures that patients can concentrate on their recovery rather than their finances. Under her leadership, Tennessee Health Advocates not only alleviates billing pains but also ensures that clients never overpay.

Nicole believes that every patient deserves an advocate. But, she’s also a champion for the advocacy profession. She understands the need for a robust network of colleagues because of her firm conviction that every advocate deserves a thriving practice. She’ll introduce listeners to “The Circle,” her contribution to the advocacy profession that empowers Independent Patient Advocates with the support and community they need to thrive in the field.

Transcript

Host

Nicole Broadhurst, thank you so much for being on the Patient Advocacy Now podcast. I'm really excited to talk to you. How you doing today?

Nicole Broadhurst

I'm doing great. Thanks so much for having me today, John. I'm excited to be here and to talk more about advocacy.

Host

Yeah, me too. Advocacy is this, it's changing fast. I feel like it's been around in the background for a long time, but really as a field, it's starting to emerge and kind of come into its own. And you have a, as an advocate, you have a really interesting specialty. Why don't you kind of go into what it is that you do?

Nicole Broadhurst

Jesus.

Nicole Broadhurst

Sure. I actually manage, audit, negotiate medical bills. I focus really on medical billing and health insurance benefits. I do do some appeals and denials and that kind of work, but I really focus on the management of chaotic medical bills. All of those pieces of paper that come in the mail that we don't know exactly what to do with and we're not really sure.

they say. I go through those, organize them, manage them, and then that advise folks on, okay what do you actually have to do with them, if anything, or can they just be filed?

Host

And nobody's, you know, a little five-year-old girl playing with her dolls saying, I wanna be a medical billing advocate. How did you kinda come into it? Because it is such a weird thing to kinda land on.

Nicole Broadhurst

Yeah, so I actually started my career in healthcare as a certified nursing assistant working second shift in a skilled nursing facility. That was where I started and I absolutely fell in love with the atmosphere of skilled nursing facilities. The nurses, the patients, the families, the residents, that whole environment just felt really comfortable to me.

having a servant heart and wanting to help people, I think that I found my comfort zone there. Unfortunately, I identified relatively quickly that I have not been gifted with the skills necessary for direct patient care. I actually had a situation where I went in to turn a resident, and as I did that, her skin caught on the sheet, and it caused a whole

horrible skin care, skin tear. Not, yeah, not, it wasn't anything, I didn't do anything wrong. My technique was good. It's just that she was very frail. Her skin was very, very thin. And unfortunately, sometimes things like that happen. However, I had a pretty traumatic response to creating that kind of circumstance for a resident.

I was not at all okay with it emotionally. And so I filled out the incident report and immediately went to my director of nursing's office and said literally in tears, I can't do this. This is not, this is not going to work for me. And she said to me, she said, well, Nicole, I just let my administrative assistant just left and would you be interested in trying that position? And I said, yes.

because that meant I got to continue to work with her and in the facility. And so that started a 27 year career on the administrative side of healthcare. Yes, so I moved from, I did a lot of things on the administrative side, but ultimately I ended up in billing and in intake where I did insurance verification and worked with benefits and all of the things. Got very, very, very familiar with the revenue cycle management.

Host

Wow. Wow.

Host

Mm-hmm.

Nicole Broadhurst

And over the years, I had patients and their families come into my office and ask me questions about these pieces of paper they were getting in the mail. And that was part of my job that really wasn't, it wasn't outlined in my scope of duties. However, it was the thing that I really enjoyed doing. Like I really enjoyed spending time with patients and families explaining what an explanation of benefits meant and

Oh, this was denied for this reason. You need to appeal this. You need to, like, I don't think this is right. And so that kind of gave me the understanding of that's what I wanted to do. So fast forward, in 2019, I left corporate healthcare in 2018. And in 2019, I launched Tennessee Health Advocates, where I get to do that every day.

Host

And so I'm assuming with COVID, it was probably more of a need than ever. And so kind of the timing for you was probably pretty fortuitous, in that it just happened that way.

Nicole Broadhurst

It was really interesting. First of all, I didn't realize that I could do this work remotely. So I had a very local flavor to my business, thus Tennessee Health Advocates. That's where I'm based. And with the onset of COVID, yes, there was an influx in not only the need, but then the ability to work remotely and help patients across the country nationwide. It just, it really did.

Host

Mm-hmm.

Nicole Broadhurst

It did explode. Yeah, in 2020 for sure.

Host

And is the practice just you or now you have people working under you? I mean, are you the head honcho and the one and only, or do you have a whole team at this point?

Nicole Broadhurst

Yeah?

Nicole Broadhurst

Yeah, so I think it's somewhere in between the two. I still, you know, I'm still the primary advocate for Tennessee Health Advocates, but I do have several contracted advocates that work with me. And together we service right now. We're servicing approximately 30 clients and that's growing. Um, so, yeah, so there's a team I, you know, I've got an assistant and I've got a couple of, of newer advocates. I.

Host

Uh huh, uh huh.

Nicole Broadhurst

If anybody's interested in taking their billing skills from the healthcare side into advocacy, I would encourage you to connect with me. That is definitely something, you have a skill set that can be used in advocacy in a very interesting and fun way.

Host

Yeah, that's a great announcement and kind of a call for people for sure. Is that what the circle is about or is that a whole different thing with you?

Nicole Broadhurst

Yes.

Nicole Broadhurst

Yeah, so thanks for asking about the circle. So super excited about that. Um, I found myself feeling very isolated and, um, working in a silo. And as I started to connect with other advocates, I learned that they felt that way too. And so I was very informal started in January of 22.

hosting a weekly Zoom call for advocates that were looking to connect with other advocates to, you know, moral support, support each other, share tools, resources, and pretty much lift each other up. You know, the attitude of abundance where, you know, personally I really believe that independent advocacy is nearing mass acceptance and awareness.

And if you're familiar with Simon Sinek's start with why this is kind of parallel, the numbers that he gives in that talk, talk about early adopters and where we are. And I really personally feel like we are getting close to that 17% of awareness where we're going to move into mass acceptance of independent advocacy. So

I believe that we really need to be ready as advocates, those of us that are doing the work. And in order for us to be ready for the masses, we need to be on our game and supported and have the best of the best tools and resources available to us. And so connecting is what that circle is all about. It's about advocates coming together, supporting each other, sharing what's working, what's not working.

so that we can all be prepared and ready to handle all of the needs that are coming around the corner. So that's that thanks for asking about the circle. I appreciate that.

Host

Yeah, for sure. And so how do you guys connect? Is it a social platform? Do you guys have meetings? What's the nature of it?

Nicole Broadhurst

Yes, yes. So we have a weekly Zoom call where we have some sort of topic, a discussion around the topic. And then we also do have a private community platform. It's actually built on a social media platform, well, a social platform, a community platform that has a very similar look and feel to Facebook, but it's a private community. So it is only for independent advocates. And...

If there's advocates that are listening that are interested, you can join us by going to thepowerfulpatient.com and join us there and get connected and we do networking and all kinds of things. We're talking about actually in the upcoming weeks, we're going to be talking about how AI is affecting us and our practices. So

You know, it really spans the gamut of anything that you might need in your practice as an advocate.

Host

Yeah, that sounds fascinating and I wasn't gonna go there but you kinda opened the door. I heard something I think on the radio, on a drive a little while ago about AI and medical coordination and advocacy. It sounds like you have your finger much deeper on the pulse there, firmer I should say on the pulse there than I do. Let's talk about that. How is AI, do you think, is it gonna affect the advocacy space?

Nicole Broadhurst

Yeah.

Nicole Broadhurst

Yeah, I think in regards to the advocacy space, so fundamentally, I believe that AI will affect the operational side of our practices. Here's what I'm gonna say. There are some things in this world that AI will never be able to replace. And I think that advocacy is one of those places. I think AI will make it easier for us to get access to information as advocates. But part of it is,

Part of the reason that I have seen advocacy grow in such a way, especially in regards to my area of specialty, which is billing and insurance, is that there's already been so much automation and removal of human touch to the process that it's created more problems. And so I think AI ultimately will give us more access to information to improve our efficiencies as advocates.

But ultimately, the advocacy work itself is very personal. It's very individualized. And I think that that human connection is always going to be part of that work. So.

Host

Yeah, I think that's a great point. I think that's the, across all industries, that's the new opportunity is how much more human can you get, that's gonna be the more security you're gonna have in your profession and the way you provide value in the world. And I think advocates are a testament to that exact thinking.

Speaking of that very personal touch, what's it like to actually work with you directly? So you said you have 30 clients they come to, there's billing that's confusing, maybe they need to negotiate, maybe they have appeals. I mean, it's a service, so is it like a retainer type of thing? How does it actually work in terms of the structure of the relationship?

Nicole Broadhurst

So one of the things that I actually have incorporated from day one is I have a flat fee structure program. It's my flagship offer. It literally is a six month program and I chose six months because what I've learned is that it's going to take at least six months to untangle any kind of medical billing issue that's already occurred. Like that's just the way that it works. And so that gives, that's a very white glove service.

Literally, those clients in that program, the only thing that they have to do is answer their phone once a week to get their update from me. And if they don't even want to answer the phone, I can leave a message and I always provide a written update each week as well. So it's literally they upload pieces of paper to me securely. I review them. I do all of the work and then I give them back the information. This is what you need to do or this is what's happening. And so you.

literally takes it off of their plate. Generally speaking, yeah, yeah, it's, it's a, it's.

Host

Sounds very, it sounds very concierge, white glove, like you said, it's just like, let me handle everything for you.

Nicole Broadhurst

Exactly. So that's my flagship offer. However, there are folks that are more of a do it yourself or kind of thing and just need some coaching and guiding. And so I do do a retainer type model with those clients so that they can pick and choose how they want to use my time. I do take a retainer of 10 hours up front, and then we work off of those 10 hours. And again, that's you know, we have regular updates.

And the client can choose how we do that. Sometimes we do it monthly, sometimes we do it weekly. It depends on the situation. I even have some time sensitive clients where it's a daily update. You know, we're trying to get an authorization, and we're trying to get something done quickly. So, and that's done on a retainer month.

Host

Yeah, that makes a lot of sense. I mean, I think that you have a couple offerings there that kind of fit the gamut. So if someone just wants to do it, if they don't have the means or they just need to do it on their own or they like doing it because they wanna get their hands a little bit more dirty in the process. And then for people who just don't have the mental bandwidth because they're loved ones in the house, just like, just take care of it. And I bet that there's, in most cases, or I'd say, I can't break it down because I'm not in your business, but you probably pay for your services

just in the savings that you bring the clients with it. So it's kind of a no-brainer kind of offer.

Nicole Broadhurst

Many times that is the case. Many times that is the case. And it depends, right? I mean, it depends on the situation and the circumstances. In fact, I have some clients who get a huge return, right? There's a big, and then I have other clients that it really is just returning time on their calendar. You know.

Host

Right. Right.

Host

Sure. Yeah, that makes sense. Do you mind? ..

explaining a little how it even works. I have no clue. I have no clue who to even call if I have an issue with insurance. And believe me, if I ever need this service, you'd be the person I'm calling. But I'm just fascinated as an individual, how do you negotiate? How do you actually challenge these bills? Is it a long written process? Is it one of those things where you've used the 27 years of relationships to get to the right people? Or is it like navigating a big corporate structure?

I'm absolutely fascinated by it.

Nicole Broadhurst

So I love this. We just submitted a case study for consideration in a white paper. And I loved this particular situation because I think the answer to your question is a little bit of all of that, right, is utilizing all of the tools and resources that are available. So here's what I'm going to give you a basic framework, right? Basic framework goes like this. You get a medical bill from a

hospital, somebody that provided services, you get the bill. You get an explanation of benefits from your insurance company. So, and, and you know, if, if you're not familiar, but you reconcile those, okay, make sure that the bill got processed by insurance correctly and that you're actually only being billed what you owe, then most of the time, I'm going to say most of the time I do a review, I'm seeing that that most bills are okay.

There's not any red flags. No, I will say that once we look at those numbers, if there's a red flag at that point, you probably have a pretty big issue. Like something hasn't processed correctly. So I think first and foremost, the biggest value that I bring is being able to look at those and identify red flags. I can't even tell you what they all are.

I do have a checklist on my website that you can go to that will walk you through the high level process of auditing that bill and give you the big red flags. So here are a couple. One if the bill that you receive is more than your deductible or more than your maximum out of pocket. Those are red flags. Okay, right? Like, right. Exactly. Yeah. And so.

Host

Sure, yeah, that sounds perfect, makes perfect sense. Yeah.

Nicole Broadhurst

Once you identify the red flag, then you got to get into, okay, what's the real benefit? How did it process? I, the biggest suggestion that I have for everybody across the board is work with the provider first. Okay, because here's the deal, they want to get paid. So if your claim has been denied, many times those providers will have either a denial department or claims team that will be working denials.

So if it gets denied, go back to the provider and see who's working that claim on the inside as the provider, because then you can team up with them.

and work to get it covered and paid. Most issues can be managed that way. Yeah, you know.

Host

That way, yeah. I love that thinking too because there's a natural financial motivation for them to solve the issue.

Nicole Broadhurst

That's right.

Nicole Broadhurst

That's right. That's right. And so I always, that's, that's always the first line to work. Yeah, because yeah, you know, you know, so the next thing that I would do is I would go to the insurance company and this can be a little bit harder. It's why it's like not the first line, right? Because now we're going to the insurance company and they usually have a bank of representatives that

Host

That's the go-to, yeah. Now when that doesn't work for some reason, what's next? Ha ha.

Nicole Broadhurst

may or may not be well versed in the claims process of how to do things. However, there are things, you know, that you got to try, right? You make the phone call, you say that here's the claim number. It looks like it was misprocessed. Can you reprocess the claim? And that's a pretty simple, like just reprocess the claim. I think this should have been paid and it will.

buy you some time to see because a lot of times what we're finding, we just talked about AI, there is this whole, and there's conversations around this, there's this whole automated front line on the insurance side that is processing claims. And I've often made a joke and I'm not sure that it's funny, but I've often said, I think that it's like a random number that they deny.

And now we're starting to see that that's coming to fruition, that that really is true, right? That, you know, a claim over the amount of X gets, you know, either denied or reviewed and delayed or whatever the case may be. So again, removal of the human element, it causes more issues on that side.

Host

Yeah, yeah, for sure.

Nicole Broadhurst

So sometimes if we just say we think it should have been paid, can you reprocess the claim? That'll buy us some time. It'll put it through the process one more time and see, because sometimes maybe it will get paid this time. So those are the two things right out of the gate that I think everybody can do.

Host

Mm-hmm.

Yeah, that makes sense. And then when it gets hairy with the insurance, that's where your almost three decades of experience really start coming into play, I would imagine.

Nicole Broadhurst

I think.

Nicole Broadhurst

Because once you get into, I've already had it reprocessed, I've already worked with the hospital, now you're starting to get a little bit deeper into the intricacies of how the adjudication process works. And adjudication is just the word used for processing claims and health insurance. That's all that means. So, but that process is a little bit intricate and

it's not as straightforward. Like I, you know, to have that kind of conversation gets a little bit more murky and confusing. So, yeah.

Host

whether it's a claim code being off or a doctor not being in networks. Like there's these weird things that come up and you have to kind of, that's where it gets very white glove and customized and all that kind of stuff, right? Gotcha. Well, you know, one thing that, just to go back to the circle for a second, I love your approach of this spirit of cooperation. When we talk to advocates, you know, off air, there is this kind of,

Nicole Broadhurst

Exactly.

Host

weird sense that there's an unhealthy competition sometimes amongst advocates. And that's, I like competition, I think it raises everybody's bar a little bit. But do you find that there is some of that still, that there are those challenges between organizations of different advocacy groups and amongst advocates on an individual level?

Nicole Broadhurst

Absolutely.

Nicole Broadhurst

Yeah. So in full transparency, my experience has been very different. First and foremost, I don't really pay a whole lot of attention. I'm really busy and I don't pay a ton of attention to what's going on. However, I will say this. One of the reasons that I started the circle is because I didn't see that community out there already in existence.

Host

Oh, okay.

Nicole Broadhurst

congregate and build those relationships without interference or without some sort of membership structure. And I think that's really important. I think, you know, I don't necessarily think that there's a monopoly. Bless you.

Host

Excuse me.

Nicole Broadhurst

on space in regards to networking and building relationships. I believe that we are all able to do that, and it just takes some intentionality. And so my goal with that was to create a community where it's comfortable. And I do know that there are some advocates that are not comfortable in that community, and that's totally fine. There's other places for that. But...

for advocates who do want to have that community and that belonging and access to each other in real time. It brings us all up, right? It allows everyone. One of the things that I said that when I called it the circle was because I wanted, so the tagline is this, the circle surrounding, where advocates surround patients with support. And the purpose was that.

Any patient that touches any advocate within that circle gets the benefits, the knowledge, the resources, and the tools of all the advocates in the circle. So because one of the things that we know about healthcare is that the only thing that's the same is change. Every single day when we show up about healthcare, something is different. As an advocate,

I cannot stay abreast of every single little thing that's changing in healthcare. Collectively as advocates, we can do that.

But we have to connect.

Host

That's a great approach. Yeah, that's a great mentality. And I'm really happy to hear that you haven't had that experience of it being competitive and that you've had doors open for you. It's actually a breath of fresh air, so I'm glad to hear that. What do you think are some, go ahead, go ahead.

Nicole Broadhurst

All good. Let me just say.

I was just going to say I was just I'm reading a book right now that was talking about we we find what we are seeking so our perspective of the world and I thought this is so true because my general perspective of the world is that people are good and that things are good and everything's a good thing and so what I found is that my experience in life reflects that back to me and so I

I think that that's probably, that's not to say that maybe I have experienced it, I just didn't see it. I think that's probably, that's not to say that maybe I have experienced it, I just didn't see it.

Host

Yeah, for sure, for sure. I think that's fair. I think the last question I have for you is looking forward to the future. What do you think some of the biggest industry challenges are in advocacy? What do you envision for the future of advocacy? I'm kind of curious to get your take on things.

Nicole Broadhurst

I hope so.

Nicole Broadhurst

on. So my dream for advocacy is that we start to really see advocates niche down into their areas of expertise. I think right now because of where we are, there's a lot of generalists in the space. And my dream is that we will, that we'll, we won't need to do that, right? That we won't need to be generalists.

that we will be able to niche down into the place of zone of genius, the things that we bring, that only we can bring to advocacy and become so strong together that we're ensuring that every single patient is getting the absolute best service provider for whatever their need is. And I hope that that's what we see.

That's my vision for that is that we can really get into being specialists in our area and get away from the generalist. I think the generalist is not as helpful as we can be as specialists. So, we'll see.

Host

And I mean, you're kind of leading the charge there by specializing in billing and specializing in insurance. Is that what you're talking about, really getting down to that kind of level?

Nicole Broadhurst

Yeah, I would love to even within medical billing. There's there's this place where I feel, you know, I even go as far as to say that my real specialty is not even appeals and denials. I can do those. But but I have members of my team, my contractors. I contract some of that out, right, because they really are specialists in that area where my real true specialty is just managing and auditing the bills.

Host

Mm-hmm.

Nicole Broadhurst

Like that's, yeah. So, yes, absolutely, 110%.

Host

on it.

So like sub, sub, sub specialties, really knowing where your superpowers are.

Host

Nicole, thank you so much for spending the time and kind of filling in the gaps on some of this understanding for me and for everyone listening. I really appreciate it. Where can, where can, before I forget, where can, I'm gonna put it in the show notes, obviously, but you mentioned where people could go for the circle. Where could patients go to work with you directly?

Nicole Broadhurst

Thank you.

Nicole Broadhurst

Thank you. Thanks so much for the opportunity.

Nicole Broadhurst

Find me on LinkedIn. LinkedIn, that's, yes, LinkedIn, Nicole Broadhurst. That's where you can find me, connect with me. It's the easiest way to do it, LinkedIn.

Host

Okay.

Host

And because you work virtually, I'm assuming you can work with anyone in the country then at that point, right?

Nicole Broadhurst

That's correct. That is correct. Nationwide.

Host

Nicole Broadhurst, thank you so much again. Really appreciate it.

Nicole Broadhurst

Thank you. Thank you.