Alyssa Lane
Medical bills can be a financial burden, but they don't always have to be paid in full. It is possible to negotiate a lower bill, even after insurance has paid its share. In the US, an estimated $195 billion of medical debt exists, and about 6% of adults owe over $1,000 in medical debt. Negotiating a bill can be done by reaching out to the billing department, healthcare provider's billing agency, or insurance company. It's important to act quickly, before the bill goes to a debt collector, and to be aware of potential billing errors, which are common. Hospitals may be willing to lower the cost if you can pay the discounted amount immediately. Additionally, non-profit hospitals are required to provide free or reduced care to patients within a certain income range. Understanding your insurance coverage and being honest about your financial situation are key steps in successfully negotiating a lower medical bill.
| Characteristics | Values |
|---|---|
| Negotiating medical bills | Possible |
| Best time to negotiate | Before receiving treatment |
| How to negotiate | Contact the hospital billing department, insurance company, and healthcare provider |
| Negotiating without insurance | More complex |
| How to negotiate without insurance | Use well-researched numbers to determine what price an insurance company could negotiate for the service received |
| Negotiating after insurance | Possible, but more complex |
| How to negotiate after insurance | Contact the hospital and/or insurer after treatment |
| Billing errors | Common |
| How to identify billing errors | Request an itemized bill and compare with Explanation of Benefits (EOB) |
| Payment plans | Possible |
| Discounts | Possible if paid in full |
| Financial assistance | Available at non-profit hospitals for patients within a certain income range |
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What You'll Learn
Negotiating without insurance
Negotiating medical bills without insurance is more complex, but it is still possible to achieve a lower bill. Firstly, you should ask the healthcare provider for an itemized bill, detailing all the procedures you received and their associated costs. It is important to carefully review this bill for any errors or discrepancies, as billing errors are common. If you notice any mistakes, contact the billing department to have them corrected.
Once you are sure the bill is correct, you can begin negotiating. It is a good idea to research the typical cost of the procedure you received, to get an idea of a fair price. You can use online tools, such as FAIR Health Consumer, to estimate the cost of a procedure in your area. You can then contact the hospital billing department and ask them to match this price. Many hospitals will offer a discount if you can pay the full amount immediately. However, this may not be an option for everyone, depending on their financial situation.
If you are unable to pay the full amount upfront, you can ask about setting up a payment plan. Hospitals are often willing to work with patients to create a plan that fits their budget. It is important to be honest about your financial situation and what you can afford. You can also try contacting a patient advocacy group, as they often have resources and programs to assist people facing financial burdens from medical bills.
In the United States, non-profit hospitals are required to provide free or reduced-cost care to patients within a certain income range. This can also be an option at for-profit hospitals, although it may be more challenging. You can search for a hospital's financial assistance programs by searching their name plus "financial assistance".
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Payment plans
If you have received a large medical bill that you cannot afford, you can take several steps to negotiate a payment plan or reduce the amount owed. Firstly, determine your eligibility for financial assistance or charity care programs offered by the hospital or government. You can search for the hospital's name plus "financial assistance" or check your eligibility for government programs like Medicaid, which provides free or low-cost medical benefits to those with low incomes. If you have children, you may also be able to apply for the Children's Health Insurance Program (CHIP).
If you are not eligible for financial assistance, you can request an itemized bill from the billing office and review it for any errors, double charges, or services you did not receive. Billing errors are surprisingly common, so it is important to carefully check your bill. If you find any discrepancies, contact the billing office to have them corrected. Additionally, ensure that your insurance company has paid for everything it was supposed to by reviewing your benefits and contacting your insurance provider if you believe a service or procedure should have been covered.
If, after reviewing your bill and confirming insurance coverage, you still cannot afford the full amount, you can negotiate with the hospital's billing department to set up a payment plan that works for your financial situation. Many hospitals will be willing to work with you to find a solution, and some may even offer discounts if you agree to pay a substantial portion of the bill upfront. It is important to be honest about your financial situation and start these conversations as early as possible to avoid negative impacts on your credit score.
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Billing errors
You should check that the "your share" amount on the EOB matches the bill. You should not be billed for anything that is not documented in your records. Double billing is common if you received care from multiple providers, so contact the billing department of each provider if you suspect this has occurred. Search for the medical billing code for each item on your bill to verify its accuracy.
Some common medical billing errors include upcoding, where an incorrect code results in a more expensive charge, and incorrect balance billing, where there is a remaining balance after your insurer has paid their share. Mismatched diagnosis/treatment codes, where the diagnosis and treatment do not align, will also result in a rejected claim.
If you identify any errors, contact the billing department and your insurance company as soon as possible. Hospital bills are generally not sent to a collections agency immediately, so you have time to negotiate before making upfront payments. You can also seek assistance from a patient advocate or a Consumer Assistance Program in your state.
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Charity care programs
According to the Affordable Care Act (ACA), hospitals must have a written Financial Assistance Policy (FAP) and a written Emergency Medical Care policy. These policies must be easily accessible to the public and include specific information such as eligibility criteria and the basis for calculating charges. While non-profit hospitals are mandated by the ACA to implement community-benefiting programs, for-profit hospitals are not required to offer charity care. However, many of them do provide financial assistance, and some states have laws mandating this.
Charity care eligibility is typically determined by factors such as income, household size, and the age of the bill. In 2025, households below 204% of the Federal Poverty Level are expected to qualify for free care, while families under 322% may be eligible for discounted care. It is important to note that each hospital establishes its own charity care program, with varying application processes and eligibility requirements. Therefore, it is advisable to contact the hospital directly to understand their specific policies.
To explore charity care options, individuals can search for the hospital's name plus "financial assistance" or utilise resources like Dollar For, which offers a form to assess eligibility for financial assistance. Additionally, the Centers for Medicare & Medicaid Services provide information about protections against surprise medical bills and offer a help desk for billing inquiries and complaint submissions.
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Itemized bills
It is important to ask for an itemized bill when negotiating a medical bill. This will show all the procedures you received and the associated code, called a Current Procedural Terminology (CPT) code. CPT codes are five or seven characters long and start with numbers or letters like "8", "9", "J", or "S". They are used to assign prices to procedures and unlock your ability to flag and negotiate inflated prices or errors.
You can obtain your itemized bill by calling the hospital, logging into your online patient portal, or sending in a release of information form. You can also request a UB-04 form, which is a standardized claim form that contains a line-item breakdown of your procedures, along with CPT, HCPCS, and revenue codes, descriptions, unit quantity, and charges.
It is important to review your itemized bill carefully and ensure the charges accurately reflect your treatment. Medical bill errors are common, so it is worth checking for duplicate charges, incorrect patient information, and costs that seem out of line. If you find any errors, document them and contact the provider's billing department to have them corrected.
Even if your bill is correct, you can still try to negotiate the amount owed. You can ask for a settlement amount or offer to pay a portion of the bill upfront in exchange for a discount. Many healthcare providers are more likely to offer a reduced rate if they know they will receive payment promptly. If you cannot afford to pay the entire bill at once, you can also ask about setting up a payment plan.
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Frequently asked questions
Yes, you can negotiate a medical bill. It is always worth trying to negotiate a lower cost, as most places just want the bill paid.
It is recommended to negotiate a non-emergency medical bill before you receive the service. However, as hospital visits are generally more spontaneous, you can negotiate after receiving treatment. It is best to negotiate before the bill goes to a debt collector.
First, understand your insurance coverage by checking your plan details. Next, contact the billing department and ask for an itemized bill. Check for any errors and, if your bill is technically correct, try to negotiate the amount owed. You can also ask for a settlement amount if you can afford to pay something upfront.
If you have a planned procedure, ask your medical provider for the estimated cost of treatment and present this to your insurance company. Check for billing errors, as they are common. You can also get a discount if you pay in full. Many hospitals will negotiate a lower cost if you can pay the discounted total immediately.
