How to Negotiate Medical Bills

Medical costs can catch you off guard and completely devastate your finances. About 16 million Americans have over $1,000 of medical debt, while another three million owe over $10,000, according to a 2022 evaluation of Census Bureau data by the Kaiser Family Foundation. Despite these grim numbers, there are many ways you can avoid putting yourself into deep medical debt and come out the other side.

1. Prepare for your medical visit

If you have health insurance, check with your provider on whether they’ll cover your visit and, if so, by how much. If the expense was previously covered by insurance, push to get it covered this time, too.

Whether your medical provider is in- or out-of-network can play a role in whether your insurance will cover your health care. Not all insurance companies will help pay for out-of-network bills, and, if that’s the case, you may need to find an in-network medical professional to work with you.

You may also need to get a procedure preauthorized by your insurance provider to ensure it’s covered. Even if a medical professional tells you it’s already been preauthorized, independently verify with your insurance company and get it in writing.

2. Know your rights

The No Surprises Act protects consumers who have health insurance from getting unexpected bills for most medical care procedures from in- and out-of-network providers. This legislation allows for insurance companies and medical providers to independently dispute with one another and come to an agreement.

Under the No Surprises Act, consumers who don’t have health insurance or who choose to not use insurance have the right to receive a good faith estimate outlining the expected expenses of their visit. You can then dispute your medical bill if it’s $400 or more than the “good faith estimate” you originally received.

3. Request an itemized bill

Medical bills can be confusing, so if you want to better understand how you’re charged, you can request an itemized bill. An itemized bill breaks down your charges line by line and explains, in detail, what services and items you’re being charged for.

Unfortunately, billing errors are not rare. Look for common mistakes on your hospital bills such as being charged twice, getting an incorrect balance or being charged for services you never had done.

By requesting and looking over an itemized bill, you can double-check that you’re being billed appropriately and ask your medical provider specific questions about what you’re being charged.

4. Ask for a lower bill

In the case that there are no errors but you still can’t pay your bills, ask your health care provider if they can lower the charges. Contact their billing department and let them know your position. Be sure to be patient and polite as this process can take some time.

While you should always try to pay your bills, it’s important to know that amounts under $500 won’t go on your credit report. This means that, in those cases, those medical bills won’t affect your credit score.

To compare medical costs, you can use resources such as Healthcare Bluebook and FAIR Health to give yourself a starting point. While you speak to the billing department, be sure to ask about any payment plan options which are covered in the next section.

5. Seek assistance programs and other options

Under the Affordable Care Act, nonprofit hospitals are required to make it clear that there are financial assistance programs in place. Ask your medical provider if they offer payment plans so you can pay off your bills in more reasonable chunks.

Patient advocates are another resource you can use as you face large medical bills. These are individuals who help guide you through the complicated maze of the health care system. A patient advocate may be able to contact your insurance company and medical provider on your behalf. You can find patient advocates in medical offices or at private organizations.

You can also seek financing options such as taking out a medical loan or applying for medical credit cards. This option is best for those that have good credit scores since they can access lower interest rates. However, there are also options for medical loans for bad credit if your history is less than perfect.

6. Appeal your insurance claim

If you believe what you’re required to pay for a medical procedure is incorrect, you have the right to submit an internal appeal and request an external review.

• Internal appeals: If your insurance company denies your claim, you have the right to submit an internal appeal. You can request that your insurance provider does a fair and complete review of their decision to deny your claim. Your state’s Consumer Assistance Program can help you through this process. If your insurance company still denies your internal appeal, then you can file an external review.
• External reviews: Within four months of receiving a denial from your insurance company, you can file an external review with either the state or federal government. How this takes place depends on where you live. While some states have their own external review process, others don’t and, in these cases, the Department of Health and Human Services will process the review. Typically, an external review takes less than 45 days.

You can check for more information about this feature on your health insurance policy by checking your explanation of benefits.