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Medical bills can come as a shock and be confusing. Maybe you went ahead with a procedure after thinking you asked all the right questions, only to get hit with an unexpected bill anyway. Or, you (or a loved one) needed emergency medical care and now you're faced with a large bill you can't afford.
Many people don't realize how important it is to review medical bills for errors. And even when everything is correct, you may be able to negotiate a lower bill or a more affordable payment plan. Here's what you need to know about reviewing and negotiating a medical bill.
How to Negotiate a Medical Bill
Negotiating a medical bill can take time and research. Your options could also depend on your insurance company, financial situation, where you live and the company that provided the medical treatment.
Ultimately, your success will depend on your unique circumstances as well as your tenacity and negotiation skills. Here are several strategies you can try:
- Ask for an itemized bill. One of the first things to do is request an itemized bill from the health care provider. It should cover everything you're being charged for with line-by-line amounts and the associated codes. Review the bill for errors, such as services or medication you didn't receive or duplicate charges.
- Look over the explanation of benefits (EOB). Your insurance company may send you an EOB. It's not a bill, but you can compare it to your itemized bill to look for discrepancies. If part of your bill should have been covered by insurance but wasn't, contact your insurance company to sort it out.
- Look into financial assistance policies. Hospitals, clinics and medical service providers may offer financial assistance to low-income patients. Some states even require both for-profit and nonprofit hospitals to have financial assistance programs. But you may need to ask about their availability. The National Consumer Law Center has a guide for helping lower-income patients deal with medical bills.
- Call the provider to ask about options. When there aren't any errors, you can still reach out to the provider to discuss your bill. You can ask if there are any waivers, hardship or relief programs available, or a discount for making a prompt down payment or full payment. Some providers may also have payment plans with low or no interest.
If you don't feel comfortable negotiating on your own, there are professional companies and individuals that will review your bills and negotiate on your behalf. But there may be a one-time fee, a fee based on your savings or a combination of the two. Ask your employer or union representative if they offer medical bill negotiation benefits, as these are sometimes available.
The major consumer credit bureaus—Experian, Equifax and TransUnion—don't include unpaid medical bills on your credit reports until at least 180 days have passed since the bill's due date. Although paid collections accounts can show up in credit reports, the bureaus will remove medical collection accounts that are paid by an insurance company.
Can You Settle Medical Bills for Less?
If you're unable to negotiate a lower bill, the provider or collection agency might accept a settlement, which is an arrangement that has you pay less than the full amount owed.
The option to settle what's owed may have already come up with the provider's billing department if you called to discuss a discount for making a payment in full, or a down payment toward a larger payment. However, their initial offer may have been too high, or the billing department may have pushed you toward a payment plan instead.
One option is to look up health care costs on Healthcare Bluebook and FAIR Health. These cost comparison sites can show you approximately how much the same procedures cost elsewhere, and can act as a reliable data point you can use during your negotiations.
Also, keep in mind that health care providers may charge different rates depending on whether you're insured, in-network or out-of-network. If you're not insured, see if you qualify for Medicaid or, at least, ask to pay the same amount as insurance companies.
If you want to make a settlement offer, you might need to mail or fax a letter. Ask the provider about the proper submission process, and then follow up a few days later to make sure the offer was received.
Look for Assistance Elsewhere
When you don't find an error and the provider won't negotiate, you could look into other options for getting help with medical bills. If you need to borrow money, medical credit cards and loans may be available. But these shouldn't necessarily be the first option you pursue—particularly if repaying the debt will make it difficult to afford essentials. Having a good credit score can help you secure financing at more reasonable rates.
If you haven't already tried, you may want to reach out to a medical billing advocate or negotiator to get a professional option. Some may agree to look over your bills for free to determine if they might be able to help.
You could also look into getting help from charitable organizations that help with medical bills. Some of these focus on particular types of patients, such as children or people who are dealing with certain illnesses. Pharmaceutical companies may also offer discounts or free prescriptions and medical supplies through a pharmaceutical assistance program. While these won't necessarily wipe previous bills, they may make your health care more affordable.