Yes, you can negotiate your medical bills.
Have a medical bill you’ve been waiting to pay? Maybe one that you’re sure is inaccurate or feels just a little too high? Yes, you may be able to negotiate it. Here’s what you need to know.
First off, up to 80% of medical bills in America contain errors [a]. And while that sounds shocking, it makes a lot more sense when you consider that most medical bills are auto-created by computer software, without human review or oversight. These systems are generating thousands of bills per day, relying on complex codes and systems that are prone to error.
That’s why you should always check your medical bills before you pay. After all, with the sheer number of inaccurate bills sent out everyday, it’s safe to assume that your latest medical bill contains at least one error. If you spot one, like an incorrect or duplicate charge, immediately contact the provider or clinic’s billing department.
But what if the bill is accurate? Is there still room to negotiate?
Even when bills are correctly generated, there are still opportunities to negotiate your bill to reduce your total out-of-pocket costs. Here’s what you need to know:
How to Negotiate Your Medical Bills
You do your homework, ask the right questions before visiting the doctor’s office, check with your insurance provider, pay your copay, get the medical care you needed, and go home. Then, weeks later, a medical bill comes in the mail. Suddenly, you owe $400 more than you expected. Now what?
Negotiating a medical bill with a health care provider or insurance company can be challenging - but that shouldn’t stop you from trying. Ultimately, your success will depend on several factors including your unique circumstances, willingness to pursue your case, and whether you have a patient advocate or medical billing advocate in your corner. Here’s where to start:
Get the itemized statement.
Billing errors are surprisingly common! When you get your bill in the mail, call your doctor’s office or billing department and ask for an itemized statement from the medical provider. It should list everything you're being charged for and include the codes for each service or medication. With the itemized statement in hand, you can make sure your bill doesn't include any mistakes—such as services or medication you didn't receive or duplicate charges. One of the most common errors is billing services associated with preventive care as diagnostic, which we’ll dive into further in another post.
Ask for - and review - your explanation of benefits (EOB).
In most cases, your insurance company will send you an Explanation of Benefits (EOB). Your EOB is not a bill, but rather a documentation of what your provider billed insurance, what your insurance covered (or didn’t cover), and what your out-of-pocket liability may be. Start by comparing the billing codes included in your EOB to your itemized bill to find any errors. Then, compare it to your actual insurance plan benefits to see if anything should have been covered by insurance but wasn't. If you find any errors, contact your insurance company immediately. This can be a particularly effective strategy when it comes to hospital bills or for patients with Medicare or Medicaid.
Ask your provider about payment options, sliding scale, and other financial accommodations.
If you’re having trouble paying your bill, providers are often willing to work with you to structure a payment plan that works for both parties. Start by reaching out to the provider and asking if there are any waivers, sliding scale, or hardship or relief programs available. You can also ask about payment plans with low or no interest - which will allow you to pay monthly installments, rather than having to pay a lump sum upfront. While monthly installments may not always lead to a lower overall medical bill, they will help alleviate your monthly out-of-pocket and allow you to preserve extra cash to pay down other debt, like credit card debt or student loans.
We know these conversations can be hard to start. Feel free to copy and paste our template below, which you can email directly to your provider or their billing department or use as a script over the phone.
Hi Dr. ____,
I received a bill in the mail from my appointment on ______ (date of appointment). I am unable to pay the bill in full today and am curious what financial support arrangements you offer. I’d love to be able to pay my medical bill, but the full amount quoted isn’t doable for me right now.
For reference, here is additional information about my appointment:
My name: _________
Appointment date: ________
Reference number (if they include it in your itemized bill): _______
Total cost: ______
Let me know.
[Your name here]
Explore your options for financial assistance.
Some hospitals, clinics, and other medical service providers offer financial assistance to low-income patients who are unable to pay their bills. Some states even require for-profit and nonprofit hospitals to provide such aid. No matter where you live, ask about the availability of financial assistance programs before paying the bill yourself.
When Should I Start the Negotiation Process?
Starting the negotiation process immediately will help keep your bill out of a collection agency, which can have a negative impact on your credit score and credit report down the line. Working directly with your medical provider or insurance company promptly after your bill arrives is the best way to avoid it being handed over to a debt collector.
How Do I Know if My Doctor is Charging a Fair Price?
Determining the fair price of healthcare in America is notoriously difficult. Companies like healthcare bluebook have created an extensive database of nationwide prices for medical services, which can sometimes help cash-paying patients - like those that are uninsured or have high deductibles - understand what constitutes a fair price for their care.
Peachy Pal helps patients get the most money back from their medical bills. We negotiate with healthcare providers to lower your total cost - and we’ll help you start that process for free, right now. Signup now