Billie Dean Howard is a medium Constance found on Craigslist. She has been helping Constance for years, trying to get Tate Langdon to move on to the next world. Billie Dean mentions she is in the process of shooting a reality show for Lifetime, in which she would help the bereaved communicate with their dearly departed loved ones. Later this becomes true, as she is confirmed to be a famous medium among celebrities.  
Appearance and Personality
Billie Dean Howard is a middle-aged woman who dresses "business casual." She often wears suit coats with jewelry or floral shirts. Her character was called a “Lee Press-On Nails Psychic” to explain her sometimes "cheap" look. Her hair is medium blonde, parted toward the right side and curled at the ends. Her complexion is pale and she wears makeup, light lipstick, mascara, and eyeliner. She has a furrowed brow and a serious expression on her face and plump, full lips. Her character as the psychic medium is self-involved and brash. She takes herself very seriously. In this, we can find a bit of humor in her personality. She is very involved in her work and gets the job done to the best of her ability. She works with Constance trying to communicate with her son, Tate. She is afraid of Tate because his presence is too strong for her to handle. While working with Constance, Billie Dean is able to explore the other spirits living in the Murder House.
Billie Dean tells Constance that a child conceived by a human woman and ghostly father would be the Anti-Christ who will bring about the end of times. 
Constance and Violet seek her help to get rid of Chad and Patrick. She tells them of one very successful exorcism, in the year 1590, at the Roanoke Colony. Billie Dean says that all settlers died and subsequently haunted the local Native Americans. One of the elders used property that the English settlers left behind and burned it. He then said "Croatoan" to cast a spell to banish them. Billie Dean recognizes that Violet is dead and speaks to her through telepathy. She tells Violet that she is sorry that she died so young. Violet pleads with her not to tell Constance. Billie Dean talks about the great evils and the energy that feeds the house, lamenting all the regret and pain many of the spirits feel. Tate then appears in the background. She is visibly shaken and states that "He cannot be here". When Violet asks what Billie Dean's reaction was all about, Constance replies that it was because it is emotionally difficult for a medium to encounter a dead person. Since Violet herself is dead and Billie Dean has no problem with her, Violet suspects this is untrue. However, she later learns the truth about Tate's background. 
Billie Dean Howard is invited at the Hotel Cortez by Iris, in order to communicate with her friend Liz Taylor's deceased boyfriend, Tristan Duffy. Billie Dean wants also to film an episode of her hit Lifetime show in the notoriously supernatural hotel. The medium wades through the sea of ghost voices and senses a strong masculine presence, and explains that Tristan simply doesn't want to speak to Liz.
On October 30th, 2022, after three TV special filmed at the Hotel Cortez, Billie Dean tries to communicate with John Lowe's ghost on Devil's Night for her TV show and then joining the serial killer dinner ghosts without her camera crew. She is threatened and told to keep her mouth shut by the ghosts and Ramona Royale, then sent running from the Hotel Cortez. 
When Madison Montgomery is tackled by Beauregard Langdon and Behold Chablis attempts a spell in order to confront the ghost, they are interrupted by Billie Dean, who warns them how dangerous is attacking the ghosts in the Murder House, introducing herself as a "medium to the stars" and recognizing Madison as a witch. Thereafter, the trio is approached by Constance Langdon's ghost coming. Later, Billie refuses to give Madison and Behold any information about Michael Langdon. 
She is a very gifted medium, with wide-ranging psychic abilities. Constance Langdon discribed her as "100% authentic". Her gifts manifested for the first time when she was 25 years old, while she was brushing her teeth and her employed's ghost showed up to her.
- Mediumship - The ability to hear and see the dead and actually communicate with spirits. She can communicate to them via telepathy and sense burdens on their minds, as guilt, regret or sadness. As well as Cricket Marlowe, Billie Dean Howard is one of only character who possesses the innate power to contact with ghosts.
- Sixth Sense - Billie can detect not only ghosts but also other supernatural species, such as the afflicted and witches. She also can sense and feel spiritual energies, such as when she comes to the Murder House and Hotel Cortez.
- Psychometry - The ability to detect and sense the history of an object.
- White Spirit Light - Billie is able to surround herself with the "white spirit light" that protects her from malevolent and dark spirits.
- To Constance Langdon: "The dead can hold a grudge better than most Scorpios."
- To Violet Harmon: "I used to be like you. Until I was 25. When out of the blue my cleaning lady shows up as I'm brushing my teeth. Except she's got no toilet brush and rubber gloves, she's naked and bloody. Her husband murdered her with an ice pick."
- To Constance Langdon: "The Holy Ghost merely whispered in the Virgin Mary's ear and she begat the son of God. If the Devil's going to use a human womb for his spawn, he's going to want a little more bang for his buck."
- To Behold Chablis: "You'll have a house full of spirits coming after you, and they aren't all as gentle as this one."
- To Madison Montgomery: "I've known a few Montgomerys in my time, but it's not every day that I see a witch."
- Billie Dean is the first character to be portrayed by Sarah Paulson. For a complete list of her characters, see Cast.
- Billie Dean Howard is the seventh character to make a crossover appearance in another season. She is hired by Iris to visit the Hotel Cortez in order to help Liz communicate with the recently deceased Tristan.
- Billie Dean Howard is the second character (after Queenie) to appear in three seasons. 
- Billie Dean is the first character portrayed by Sarah Paulson to possess some form of supernatural power, the second being Cordelia Foxx in "Coven".
- Billie Dean's appearance may be a nod to Allison DuBois' appearance on The Real Housewives of Beverly Hills.
- Ryan Murphy stated in the weeks before Michael Langdon's birth that Billie Dean's theory about him being the Anti-Christ is not necessarily true, though this may have been to provide an element of surprise for fans before the season finale.
- This is finally proved to be true during Apocalypse (story).
- Billie mentioned that negative energy could appear in places such as prisons and asylums, trapping ghosts in their depths forever. The second season of American Horror Story is set in an insane asylum; ironically, no ghosts appeared in the second season.
- It is revealed in "Be Our Guest", the season finale of "Hotel", that in addition to being able to see ghosts, Billie Dean is also able to identify other supernatural species, as evidenced by when Ramona Royale confronted her and Billie was able to tell right away that she isn't human or a ghost.
- In a conversation with John Lowe, Billie Dean stated that in order to protect herself from malignant ghosts, she surrounds herself with "white spirit light" - the same thing Misty Day said to Fiona Goode in "Coven", and later Cricket Marlowe to the Miller family in "Roanoke" - himself a psychic medium.
- Billie Dean may be related to Timothy Howard, a character featured in "Asylum".
- Assuming that "Apocalypse" takes place in 2021, Billie Dean somehow survives the nuclear war and stands firm as a famous reality television star, as shown in "Be Our Guest ".
- Thus far, she is the only character portrayed by Sarah Paulson known not to kill anyone.
- Thus far, she is one of the only Murder House (story) characters to have not died.
- ↑ 1.0 1.1 1.2 Episode: Be Our Guest
- ↑ 2.0 2.1 2.2 Episode: Return to Murder House
- ↑ Episode: Piggy Piggy
- ↑ Episode: Spooky Little Girl
- ↑ 5.0 5.1 Episode: Birth
- ↑ Webb Mitovich, Matt (2018-08-03). American Horror Story: Apocalypse Characters Include Billie Dean, a Bitchier Madison... and the Harmon?. TV Line. Com. Retrieved on 2018-08-03.