Understanding Medical Bill Negotiation: Tips For Post-Insurance Adjustments

Negotiating medical bills after insurance can be a complex process, but it is possible to reduce costs and get financial assistance. You can reach out to your medical provider for the estimated cost of your treatment, present this to your insurance company, and then speak with your hospital’s billing office to see your options. When reviewing your bill, check for any errors that might have been made when the hospital entered your costs and services for billing. Many hospitals will negotiate a lower cost if you agree to pay that discounted total immediately.

Negotiate before treatment

If you have a planned procedure or scheduled medical services, you can negotiate your bill before receiving treatment. You can reach out to your medical provider for the estimated cost of your treatment. Present this to your insurance company to see how much your health plan will cover. Now that you know how much you’ll be paying out-of-pocket, speak with your hospital’s billing office to see your options. When reviewing your bill, check for any errors that might have been made when the hospital entered your costs and services for billing. Billing disputes due to errors on medical bills are more common than you might think.

You can say something like, “I can’t afford the full price of what you’re charging, even after insurance," and then suggest a smaller, immediate lump-sum payment, or an amount that you can pay each month for a set amount of time. Many hospitals will negotiate a lower cost if you agree to pay that discounted total immediately.

If you feel your bill was improper—if, for example, you were led to believe that a service would be covered by insurance and it wasn’t—you should also mention that to strengthen your case.

If you don’t have a loved one who is an ace negotiator, you can look into groups like PAF, Solace, and the nonprofit Dollar For, all of which offer patient assistance. You can also request a three-way call with your provider’s billing office and your insurance company if you’re hearing different things from each side. If your bill is correct but higher than you can afford or think is appropriate, it’s time to negotiate.

First, call your provider’s billing department and ask whether they offer financial assistance, since many hospitals and health systems provide free or discounted care to certain patients.

Check for errors on medical bills

When negotiating medical bills, it is important to check for errors on medical bills that might have been made when the hospital entered your costs and services for billing. Billing disputes due to errors on medical bills are more common than you might think.

• Review your bill carefully and look for any discrepancies or mistakes.
• Double-check the accuracy of the charges and ensure that all the services and procedures listed are correct.
• Verify the coding and billing codes used by the hospital to ensure they are accurate and relevant.
• Compare the bill with the initial estimate or discussion you had with the medical provider to ensure that there are no surprises.
• Look for any missing or incorrect information, such as patient details, dates, or specific services provided.
• Don't be afraid to ask questions and seek clarification from the hospital's billing department if you notice any errors or discrepancies.

By thoroughly checking for errors, you can identify any potential issues with your medical bill and have them corrected before finalizing the payment. This can help ensure that you are not overcharged and that your insurance coverage is applied accurately.

Use well-researched numbers when negotiating

When negotiating medical bills after insurance, it's important to have well-researched numbers to support your case. Here are some steps to help you with this process:

First, review your insurance coverage and understand the terms you agreed upon. This will help you determine what price an insurance company could negotiate for the service you received. You can use online tools like FAIR Health Consumer to estimate the cost of a medical procedure in your area.

Next, contact your healthcare provider's billing agency and polite ask them to honor that price. Many hospitals will negotiate a lower cost if you agree to pay that discounted total immediately.

When reviewing your bill, check for any errors that might have been made when the hospital entered your costs and services for billing. Billing disputes due to errors on medical bills are more common than you might think.

If you feel your bill was improper, for example, you were led to believe that a service would be covered by insurance and it wasn’t, you should also mention that to strengthen your case.

Finally, if you're having trouble negotiating, you can request a three-way call with your provider’s billing office and your insurance company if you’re hearing different things from each side.

Ask for financial assistance

If you have a planned procedure or scheduled medical services, you can negotiate your bill before receiving treatment. You can reach out to your medical provider for the estimated cost of your treatment. Present this to your insurance company to see how much your health plan will cover. Now that you know how much you’ll be paying out-of-pocket, speak with your hospital’s billing office to see your options. When reviewing your bill, check for any errors that might have been made when the hospital entered your costs and services for billing. Billing disputes due to errors on medical bills are more common than you might think.

If you feel your bill was improper—if, for example, you were led to believe that a service would be covered by insurance and it wasn’t—you should also mention that to strengthen your case.

First, call your provider’s billing department and ask whether they offer financial assistance, since many hospitals and health systems provide free or discounted care to certain patients. If your bill is correct but higher than you can afford or think is appropriate, it’s time to negotiate. You can say something like, “I can’t afford the full price of what you’re charging, even after insurance," and then, either suggest a smaller, immediate lump-sum payment, or an amount that you can pay each month for a set amount of time.

Many hospitals will negotiate a lower cost if you agree to pay that discounted total immediately. If you don’t have a loved one who is an ace negotiator, you can look into groups like PAF, Solace, and the nonprofit Dollar For, all of which offer patient assistance. You can also request a three-way call with your provider’s billing office and your insurance company if you’re hearing different things from each side.

Often times this whole process is a negotiation, the hospital is trying to get as much money as possible because the insurance companies are trying to pay the least amount possible and they know certain patients won’t pay all together, so you will have some room to negotiate as some money is worse then no money.

Select another plan with more ER coverage

If you have a planned procedure or scheduled medical services, you can negotiate your bill before receiving treatment. You can reach out to your medical provider for the estimated cost of your treatment. Present this to your insurance company to see how much your health plan will cover. Now that you know how much you’ll be paying out-of-pocket, speak with your hospital’s billing office to see your options. When reviewing your bill, check for any errors that might have been made when the hospital entered your costs and services for billing.

If you feel your bill was improper—if, for example, you were led to believe that a service would be covered by insurance and it wasn’t—you should also mention that to strengthen your case. Many hospitals will negotiate a lower cost if you agree to pay that discounted total immediately.

If you don’t have a loved one who is an ace negotiator, you can look into groups like PAF, Solace, and the nonprofit Dollar For, all of which offer patient assistance. You can also request a three-way call with your provider’s billing office and your insurance company if you’re hearing different things from each side. If your bill is correct but higher than you can afford or think is appropriate, it’s time to negotiate.

First, call your provider’s billing department and ask whether they offer financial assistance, since many hospitals and health systems provide free or discounted care to certain patients. Then, either suggest a smaller, immediate lump-sum payment, or an amount that you can pay each month for a set amount of time. “They know on some human level that not very many people can afford a, say, $10,000 bill,” Donovan says. “They want to get paid,” even if the payment is less than what they originally charged, “and you should use that to your advantage.”

What are the terms you agreed with your insurance company? Perhaps, next time you can select another plan with more ER coverage? I would call the finance and billing department, they typically expect to write off certain costs every year as a result of patients who can’t afford treatment and may be willing to work with you. Often times this whole process is a negotiation, the hospital is trying to get as much money as possible because the insurance companies are trying to pay the least amount possible and they know certain patients won’t pay all together, so you will have some room to negotiate as some money is worse then no money.

Frequently asked questions