You’re Not Charging Enough, and It’s Hurting Our Entire Profession

  • What is it worth to find someone who can save your life?
  • What is it worth to find someone who can provide quality to a life that has little or no quality because of health problems?
  • What is it worth to find someone who can save you tens of thousands of dollars, or to prevent you from going bankrupt?
  • What is it worth to find someone who can alleviate your fear, and provide peace of mind?


I can tell you what it’s worth based on what I read in the press, in the APHA Forum, in my email and based on feedback from many of you:

On the high end, it’s worth about $350 an hour.

But on the low end, every day, many of you behave as if it’s worth is $0. Nothing. Zero. Nada. Zip.

And in most cases, you don’t realize that is what you are doing.

Why do I say that?

  • Because many of you offer your services for free, and are then surprised that someone won’t pay you for more work.
  • Because advocates volunteer to help people every day when those people say that they think an advocate is “too expensive” even when they have the means.
  • Because too many of you are willing to accept too little money for your work, which actually devalues our entire profession.

Ouch. Let’s look at each of these points more carefully.

We’ll begin with a reminder that what you charge someone to do the work the work they need is as more about the VALUE of what you bring as it is to the price you charge. That’s why I led this post with the value questions. What IS it worth to work with someone who can save your life, or your life savings? When potential clients understand that your value proposition is that important, they are ready and willing to pay you. We know this because it happens every day for those advocates who are willing to hold true to their pricing.

And yet – so many of you are offering free assessments. Or provide free transportation. Or you are volunteering to help someone for free or reduced prices because you feel sorry for them, and because they tell you your services are too expensive. Or you aren’t charging them for all the work you do. Or you are afraid of giving them an estimate for services that truly represents the amount of work it will require.

But how does one find a balance behind “too expensive” and life or quality-of-life saving?

I’m not going to answer that here – but there are answers for helping potential clients understand that you are worth paying for – and paying top dollar for. We actually addressed that in last week’s APHA Expert Call-in, “Managing Potential Client Phone Conversations So They’ll Sign a Contract with You“. (APHA Members can listen to the podcast and find the resources by logging in to their dashboards, then clicking on that link.)

In The Health Advocate’s Start and Grow Your Own Practice Handbook, there is a thorough discussion of how to set your prices, and how to discuss them with potential clients. The “setting your prices” part is important because it’s a combination of doing the math and assessing the value of your work.

There’s also a course at PracticeUP! Online that walks you through setting your prices using your own information.

That combination is understood universally by anyone who ever pays for anything. Whether you are buying a candy bar or a new car, spending a couple of hours with your hairdresser, or working with an advocate to weather a healthcare storm – the price/cost of something ISN’T about what it cost to make it and sell it – it’s about the value TO YOU of the purchase.

If YOU, the advocate, look at your time and skills as something that doesn’t cost you anything (after all, it’s only TIME), then you are sorely mistaken. Your time is the only thing you have to sell. Your expertise comes from years or decades of experience and education. So when you turn around and “sell” your time – for nothing! for free! – you are devaluing everything you have done to that point.

Further, you are devaluing what every other advocate has learned or experienced to that point, because you are, in essence, saying that what advocates bring to the table in time and expertise has no value – is worthless.

I know – harsh.

Then, finally, there is ECON 101 concept of “opportunity cost is opportunity lost.” That is, time cannot be recovered. So if you waste an hour, you have wasted what that hour could have produced for you. If you spend an hour volunteering, or charging less than your work is worth, then you also lose what that same hour could have produced if you had been paid $150 or $350 an hour, or if you had been marketing your services for the potential client who will pay you that much. The cost to you is the difference – the lost opportunity.

It’s certainly not, “Well gee, it doesn’t cost me anything, so it’s OK to give someone the answer for free.” Too many of those lost opportunities will put you – PLUS all the other advocates who have value priced their services and charge clients fairly – out of business.

I hope I have made the case for understanding the value of what you, as a private advocate, bring to clients. I hope I have also made you look at how you are currently delivering your services and charging clients as not just a question of how you grow your own business, but how it affects the advocacy practices of others, too.

When you help potential clients understand the value of your work, and charge accordingly, it will compel them to pay top dollar for your services. When you accomplish that balance, it will be win-win-win – not just for you and your client, but for our patient advocacy profession, too.

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Share your experience or join the conversation!


5 thoughts on “You’re Not Charging Enough, and It’s Hurting Our Entire Profession”

  1. I had a very instructive conversation with a potential client last week. First, though, I have to comment that I typed up the notes from your call in and had them in front of me, to use as steps to steer the conversation. And it was very helpful!

    This client was looking at a number of advocates, and she told me that an advocate she had spoken to charges $50 per hour. I had just told her I didn’t think any charged less that $100 per hour! So not only am I wrong about that, but I see that there are advocates who are still undervaluing what they provide. Too bad!

  2. I think there are 2 issues here. The first one is free services, time or advice that, for whatever reasons, we may give away. Guilty as charged.

    The second is the fees we actually charge. I strongly disagree with the $ 350.00 an hour fee. Even $ 150.00/hr is too high for most services. $ 350.00/hr to file a Medicaid form or go to an appointment. Really? Unless your expertise and credentials are that of a MD or lawyer, how do you justify such pricing?

    I offer free initial consultations. I have learned not to give the strategy away, and do provide an work description and hours estimate. Every type of business does that. Yet a client I signed last month was asked for a large retainer by a prospective advocate, without any estimate, description of services and expected time frame or number of hours. Would you hire a mechanic or a orthodontist, or an advocate for that matter, without one, based uniquely on vague promises?

    Many advocates ask for a commission on savings, which I do. If one does not, a higher hourly fee should be asked. If both are expected, good luck convincing clients!
    Just last week, I signed 2 clients who were quoted “outrageous” and “bordering on a rip off” fees (their word) for the services I will render for less. Am I losing money? no. Am I sure of getting grateful referrals in return? you bet: already had one call from a friend.

    Asking way too much for services which often don’t require more than a few months’ course, specialized skills or extensive expertise WILL hurt our profession. There must be a scale, based on common sense, experience, complexity, and other tangible criteria to determine what a contract is worth. Blindly throwing a high fee, without strong backing in credentials or experience, can only cast a shadow and negative reputation on us. I want us to get paid! But being realistic about the value of a service is part of being in business, and most important to stay afloat.

    This is our chance to build something great from scratch. The word is spreading, and we will have more and more clients. My practice has been booming the last few weeks. I am collaborating in a few projects which will propel it, and this profession, further up.

    But if we only cater to an elite, what message will we send in the name of patient advocacy? I don’t want to be typecast as those lawyers, doctors or mechanics out to make a buck at the expense of the clients they claim to help. We are on the brink of an explosion of work and clients and income, damn I am working hard for it. Our reputation is being built now. I am merely suggesting we not blow it by a lack of self-control and common sense, before we have a chance to prove our worth and establish a solid foundation. The alternative would be disastrous for all of us.

  3. Marilyn Bradfield

    I’ve been doing advocacy since 1982. I was involved in the development of many medical tv series and movies. I understand worth!
    Marilyn Bradfield

  4. completely agree with the free or undercharge. I had to put a message in my website’s contact form explaining that I would not give out free advice via email!

    As for the $350/hour, it depends. but I have a lot of patients (I’m a physician) that have chronic diseases, and I find it really difficult to maintain the same hourly rate that I did at first, and I also find it very difficult to make a “package.”

    Also, Europe is, as far as I can see, cheaper than the US, so 350 euros would never fly here.

    But I am having a hard time figuring out the payment schemes, specially for long time patients.

  5. I know this is an older post. But, I just came across it, at the perfect time. Business has been slow and the last couple calls I’ve taken decided not to hire me because I am too expensive. I am struggling financially and was considering reducing my hourly rate. It’s just so hard when we live in a country where people are not accustomed to paying out of pocket for healthcare expenses. They expect insurance to pay for everything. It’s tough to get them past that, in my experience.

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