Health plan designers are giving patients more “skin in the game” by increasing deductibles, co-payments and coinsurance amounts.

Narrower provider networks are increasing the risk that the patients will get more out-of-network care, even when they do everything they know how to do to get in-network care.

The new Patient Protection and Affordable Care Act (PPACA) open enrollment calendar system for individual major medical coverage may lock patients into policies even if their primary care providers leave the provider network, or the plan drops coverage for the patient’s medications.

Meanwhile, the new PPACA system is putting pressure on insurers to cut their administrative expenses, and insurers are responding by cutting what they pay agents and brokers. Both insurers and producers are struggling to offer enrollees the kinds of problem-resolution services they offered in the past.

Stand-alone patient advocacy services are trying to fill the void by offering these services. One of the pioneers in the market, Health Advocate Inc., has broadened its offerings to include biometric screening, tobacco cessation help, and other wellness and condition-management services as well as patient advocacy.

A new company in the market, Ultimate Settlements Inc., is trying to take a different approach, by focusing tightly on bill negotiations for health insurers, employers, benefit plan administrators, brokers and the patients themselves.

J.L. Fersch Jr., the founder, used to negotiate with hospitals and other providers for workers’ compensation insurers and automobile insurers. He sold that payment negotiation firm, National Health Quest, to Mitchell International Inc. in 2012.

In 2014, he had to handle bill negotiations for his own family when doctors found that his wife had cancer. Even though he had specialized in handling medical bill negotiations for property-casualty insurers, he found that he had to spend hours on the phone resolving his wife’s billing problems.

The company “is very interested in plugging in our services with brokers and benefit plan administrators, because we believe that we can provided the options to allow the brokers and administrators a competitive edge,” Fersch said in an email interview.

See also: 3 ways patient credit programs could grow