How To Negotiate Medical Bills

Just under a third of those in debt owe at least $10,000 in medical bills.

CNBC, 2020

In February of 2020, CNBC reported that almost a third of American workers have some medical debt. Just under a third of those in debt owe at least $10,000 in medical bills. And these figures come from people who do have health insurance.

Many Americans know the struggle of a giant hospital bill, but most don’t know that these bills are not set in stone. Read on to learn how you can negotiate medical bills into something less stressful and a bit more manageable.

A Federal reserve report from May 2019 found that forty percent of Americans cannot afford to cover an unexpected expense of $400. In other words, a single surprise medical expense could send most American households spiraling into debt or even bankruptcy.

Medical bills are serious problems for Americans, and they may be about to get worse. With the rapid spread of COVID-19 across America, many people see long hospital stays—and large medical bills—as a result of the virus.

So, what can you do when you need help with medical bills?

You may have more options than you think.

In some cases, inaccurate medical bills may cause you to pay more than you need to. This is where you might have grounds to negotiate. This step-by-step guide will break down the basics of advocating for yourself and negotiating medical bills.

Negotiating Medical Bills: Getting the Big Picture

Before you can negotiate medical bills, you have to know what’s on the bill—precisely and in full detail. The reality is that most bills don’t show you the whole picture. You need to make a phone call to the billing department and request an itemized bill, which lists every single good and service you are being charged for, from surgery to a single bandage.

Once you have this information, there are two things you can do: 

  • Check the bill itself for issues.
  • Make sure you’re not unfairly charged.  

Errors in medical billing occur more frequently than they should, and many times, these errors are never caught because patients don’t realize there’s an error. 

Go through the bill line by line and make sure it only contains what it should. Are you being charged for two ibuprofen when you were only given one? Even worse, are you being charged for an item or service you never received? 

Don’t forget to make a copy or two of your bill so you can write notes or modify it as necessary for your own records.

Are You Being Charged Fairly?

Another step you can take is to make sure you’re not being unfairly charged. Organizations like Fair Health Consumer and Healthcare Bluebook provide online tools for patients to compare health care costs. Using these tools, you can look up your procedures and see what other providers in your area are charging. If your cost is higher than other providers, use that information to negotiate the charge down.

For example, say you live in Minneapolis, Minnesota, and have been seeing your doctor about frequent heartburn. The doctor recommends an endoscopy, a procedure where a small camera is put down your throat and into the stomach to check for things like a hernia or cancer. 

When you receive the bill, you have been charged $400 for the procedure, despite having used a provider within your insurance network. Using Fair Health Consumer’s online tool, you find that the average cost of endoscopy in your area (with an in-network provider) is $226. With this information in hand, you can make a compelling argument to the billing department that you’ve been overcharged.

Talk to Someone About Your Bill

That brings us to step number two. Once you’ve examined your itemized bill, there are two groups of people you can talk to about what’s on it: your health insurance provider and the hospital or clinic billing department. These two groups are the people with whom you can work to negotiate your medical bills.

Speaking with Your Insurance Company

negotiating medical bills

First, you should make sure that your insurance has covered their part of your bill correctly. Unfortunately, that requires really knowing the ins and outs of your health coverage. 

To many people, health insurance is a bit of a mystery. Knowing how your plan works, precisely what’s covered, and how much can help you negotiate your medical bills with your provider.

Sometimes insurance providers don’t pay their share of medical expenses even when they should. Here are some questions you can check to make sure your provider has paid their fair share.

Did You Use an In-Network Provider?

If your insurance company uses a network, then finding care in-network will be less expensive than going out-of-network. Make sure you’re not being charged out-of-network prices for an in-network provider.

Have You Met Your Yearly Deductible?

Unfortunately, this may not help you very much if you have a high deductible insurance plan. But regardless of how high your deductible is, if you have already met it, your insurance company should be at least partially covering any care outlined in your insurance plan.

Is Your Care Covered? 

Keep in mind that your health plan might not cover all health care costs. One way to minimize your health care costs is to make sure that your procedures are covered before you schedule them, when possible. Uncovered procedures lead to significant medical bills.

Is Your Care Fully Covered? 

Additionally, some insurance plans only partially cover certain care. For example, an insurance company may only cover a procedure at 50% or 80%. However, if you carefully examine your plan and your bill, you may find a case of insurance error. If a procedure is only being covered at 50%, yet is listed in your plan as covered at 100%, you should demand the insurance company cover the full cost of that procedure.

Speaking with the Hospital’s Billing Department

After you have made sure your insurance provider is properly covering your care, the next place you should call is the service provider’s billing department. Once you have someone on the phone, there are a few different steps you should take.

First, you should address any of the billing errors or unfair charges you found when you examined your itemized bill. Once these are taken care of, there are two common strategies that you can use to negotiate medical bills: bill reduction or a monthly installment plan.

Bill Reduction

The strategy of bill reduction is precisely what it sounds like; you ask for an overall reduction of your bill. Many health care providers will grant discounts up to ten or twenty percent, especially if you can pay the entire reduced bill at once with cash. Some providers call this option prompt pay. Prompt pay is a great option for relatively smaller bills or for people who can cover most of the bill but not the entire thing.

Monthly Installment Plans

Prompt payment of medical bills isn’t always an option. A twenty percent reduction of a thousand-dollar bill is still eight hundred dollars, after all—twice the amount that most Americans can afford to spare unexpectedly. If your bill is too high for prompt pay, you can ask your billing department for a monthly payment plan. Be clear with your health care provider about what you can afford to pay per month. 

When you speak with the billing department, begin by using open-ended questions:

  • What discounts are available for patients experiencing financial hardship?
  • Are there alternatives to paying the bill in full?
  • What fees can be waived from my bill?

Your provider may bring up the prompt pay or installment plan options. If they don’t, you should.

When Negotiating on Your Own Isn’t Enough

In some cases, you may not be able to negotiate medical bills on your own. You might need to enlist professional help. Fortunately, health consumer advocates can fight unfair medical bills on your behalf. These patient advocates will know your state’s billing protection laws in detail and will bring their expertise to work for you.

However, in most cases, these services come at a cost. Both for-profit and nonprofit advocates exist, but most charge either an hourly fee or a percentage of their services’ savings. Some nonprofit agencies may do pro bono work if you have a diagnosed chronic or life-threatening condition.

If you’ve done all you can to negotiate your medical bills and are still struggling to pay them, a medical billing advocate may be your best option. After all, they deal with medical billing every single day. Check with your state’s bar association to find an advocate near you.

Don’t Give Up

When you’re struggling to pay for your medical care, it’s easy to feel like you’re out of options, but that’s not true. Examining your itemized bill, knowing the details of your health coverage, and speaking to providers about your options can make all the difference in the world. As a health care consumer, you have the right to negotiate your medical bills. Don’t give that up without a fight.