Let’s Talk About Money: The Conversations We Avoid but Shouldn’t

At the start of the COVID-19 pandemic, I was searching for ways to give back—ways I could support the community in a strange and uncertain time. My advocacy business began as volunteer work. With a background in healthcare, particularly medical billing and the insurance claims cycle, I started offering free phone calls to help people choose health insurance plans or understand their existing benefits.

After supporting a few folks in my neighborhood, my partner encouraged me to consider charging for my work. Starting a business had never been on my radar, and truthfully, it’s not something I ever desired. But as I entered a graduate program in Social Work, I began to understand the value of my time and labor. Altruism can feel good in the moment, but I also knew it was possible to do work I love and get paid for it. And so, MK Consultations LLC was born, and I began taking on clients. 

Building an Ethical Business Model

Talking about money has always been hard for me in healthcare—whether it’s explaining out-of-pocket costs, taking payment, or acknowledging that health insurance doesn’t always meet people’s expectations. I knew that if I was going to charge for my services, my rates had to feel right to me. My guiding principle was if I can’t afford my own hourly rate, I shouldn’t charge it.

Within months I quickly transitioned to a sliding scale model using the Green Bottle Method created by Alexis J. Cunningfolk. A colleague also coached me on how to discuss cost as a fluid, ongoing conversation, rather than a rigid one-time exchange. This led to a financial model rooted in transparency and honesty. Some clients pay my full rate while some pay half. When someone loses their job, I often offer pro bono services for a month or two. I’ve even had a client double my hourly rate at the end of our work together because they felt so supported. In three years, I’ve never felt taken advantage of, nor have I ever had to deny someone my services due to money.

When someone loses their job, I often offer pro bono services for a month or two. I’ve even had a client double my hourly rate at the end of our work together because they felt so supported.

For transparency, this is part-time work for me. I’ve rarely taken on more than twenty hours a week and prefer to keep it around ten to make space for other work commitments. Even with that, the business sustains itself—all my business expenses are paid and I pay myself a small monthly income. This work has become a financial safety net during a nine-month unpaid internship and is currently helping me pay off my student loans.

The Client Case

Fast forward to Fall 2024. A man in his 60s—let’s call him Frank—was hospitalized after a heart attack and ended up with a $250,000 hospital bill. He reached out for help, and together we were able to get the bill fully written off based on his income. Frank works full-time, but his income is low, and his healthcare needs are higher than average. After resolving the bill, we identified other areas where he needed continued support, like scheduling appointments, understanding lab results, and managing his health goals.

This kind of work can be intensive, especially with Frank’s preference for regular in-person meetings. Thankfully, I had space to take him on at a discounted rate of $100/month.

By Summer 2025, I’d decided to take my business in a new direction, which is a story for another time. This meant I needed to end my work with Frank and find him a replacement. My biggest fear was the emotional impact; we had built a strong rapport, and transitions can be hard for him. What I didn’t anticipate was how hard it would be to find someone affordable.

A Broken System

I began my search on Facebook advocate groups, professional directories, and private nursing companies. Rates ranged from $250 to $350 per hour—completely out of reach for someone like Frank. I searched for people who offer pro-bono hours and sliding scales and came up with nothing. I even reached out to professionals online whom I had never met and let them know Frank’s situation and his budget of $200/month. The people who got back to me often never even asked how many hours a month he needed- they simply said they cannot help him at the price point. 

It broke my heart.

I turned to nonprofits, but many of them offer only resource referrals or focus on specific crisis populations—people who are unhoused, survivors of domestic violence, etc. Frank doesn’t fit those categories. He works full time, has housing, a car, and access to food. On paper, he doesn’t look like he’s in crisis. But Frank lives with a traumatic brain injury that affects his executive functioning. He’s a heart attack survivor with multiple chronic conditions and limited capacity to prioritize healthcare spending. As a social worker, I would say his Social Determinants of Health are of concern, and without some assistance, he is going to slip through the cracks of our healthcare system. Leaving Frank with no one to take over for my role is not an option.

We Need to Talk About Ethics

To be clear, I am not suggesting that anyone should suffer financially to serve others. Fair compensation for labor is non-negotiable. But if your business cannot withstand the occasional discounted rate for someone in need, your financial model is fragile to begin with. 

I cannot, in good conscience, call myself an advocate if I only serve people who can pay $300 an hour. I believe if independent patient advocates don’t work with low-income clients, don’t transparently talk about costs, then they are complicit in the very healthcare inequities they claim to be fighting. Similarly, if they don't have any clients who are Black, Brown, or LQBTQIA, you are likely playing a role in the lack of access to care that we already see in our healthcare system. 

I believe if independent patient advocates don’t work with low-income clients, don’t transparently talk about costs, then they are complicit in the very healthcare inequities they claim to be fighting.

I’ve wrestled with this for weeks. I’ve asked myself: Am I being unrealistic? Is it naive to think $300/hour is unethical? I’ve had many people tell me I should charge more, that sliding scales are too complicated, or that I’m putting myself at risk. But if I’ve been able to build a sustainable business model that includes discounted rates and pro bono work while also paying myself, why can’t others? (and I’m only doing it part-time!)

And then I read an email from writer, sociologist, womanist, and educator Nikki Blak that captured everything I’ve been thinking. 

“You don't have to choose between being ethical and experiencing abundance.”

That’s it. I don’t have to choose—despite what capitalism tells me. So I’ll keep using my sliding scale, doing the work I love, staying grounded in my values, and experiencing abundance on my own terms.

And yes—good news: I found someone to take over Frank’s care. A healthcare professional with over 30 years of experience who volunteers in their spare time, who has the capacity to meet with Frank regularly, and who can work within his budget.

It can be done.

UPDATE: The healthcare professional who was going to take on Frank’s case ended up not working out. As I started the search process again, I did find another advocate who can work within Frank’s monthly budget. 

Again- it can be done. 

Editor's note: Want to hear more from Morgan? Watch Morgan's podcast on TikTok Health Literacy.