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Dealing with medical bills can be stressful, especially when the charges are unexpectedly high. However, the “amount due” on a medical bill is not necessarily set in stone. Negotiating medical bills is a common practice, and many health care providers are open to discussions about reducing costs or setting up a manageable payment plan.

Whether you’re dealing with a large hospital bill or an unexpected charge from a doctor’s visit, these six steps can help you effectively negotiate your medical bills and potentially save you thousands of dollars.

1. Ask for an Itemized Bill

A good first step in negotiating a hospital bill you can’t afford, or any type of medical bill, is to ask for a complete breakdown of charges. An itemized bill will list every service, procedure, and medication you’re being charged for, providing full transparency. This can be particularly helpful if you’re looking to negotiate a medical bill after insurance. You can compare the itemized bill with your Explanation of Benefits (EOB) document and verify that the charges align with your coverage and what you’re responsible for paying yourself. Reviewing your bill can also identify any billing mistakes (more on that next).

2. Check for Billing Errors

Billing inaccuracies — from duplicate charges to incorrect billing codes — are surprisingly common in the medical industry and can be highly costly to consumers. When reviewing your itemized bill, you’ll want to keep an eye out for these common billing errors:

•   Duplicate charges: Ensure you haven’t been billed multiple times for the same service or medication.

•   Incorrect services: Verify that you’ve been billed only for treatments and procedures you actually received.

•   Incorrect billing codes: Mistakes in medical coding can lead to inflated charges. Look over your bill (you may have to look up the CPT codes online) and ensure the charges accurately reflect your treatment.

•   Unbundled charges: Sometimes a group of procedures that occurred together (and should be charged under a single code) get listed as separate services. Keep an eye out for any services that appear to have been “unbundled.”

If you spot errors, you’ll want to contact the billing department immediately to have them corrected. Be sure to document your conversations and keep copies of all correspondence for reference.

Recommended: How Does Debt Consolidation Work?

3. Ask About Financial Assistance Programs

Many hospitals and health care providers offer financial assistance programs to help patients struggling to pay their bills, but they may not make you aware of them unless you ask. These programs are often based on income and can provide significant discounts or even forgive a portion of the debt entirely.

When speaking to the billing department, ask if you might qualify for any of the following:

•   Charity care programs: Designed for low-income patients, these programs can reduce or eliminate medical debt.

•   Sliding scale discounts: Some providers adjust fees based on your income level.

•   Hardship waivers: If you’ve experienced financial difficulty due to a job loss or medical emergency, you may qualify for reduced bills.

If assistance is available, you’ll likely need to apply. This typically involves submitting information about your budget, the assets you own, recent tax returns, and proof of income (e.g., pay stubs).

4. Ask for a Lower Bill

Sometimes, all it takes to reduce your medical bill is to ask for a discount. Many health care providers have flexibility in their billing and are willing to negotiate with patients, especially if you’re uninsured or paying out of pocket.

When negotiating your medical bill, keep these tips in mind:

•   Be calm and polite: Getting angry or becoming emotional generally won’t work in your favor. For your best chance of success, you’ll want to explain your financial situation in a clear and calm way, then politely (but assertively) ask if the provider can offer a discount.

•   Offer to pay right away: Many providers are willing to offer a reduced price — or “settlement amount” — if you agree to pay immediately, as it saves them the hassle of pursuing collections. You might ask if they can offer a self-pay discount if you pay all or part of the bill that day. This strategy could result in as much as 30% to 50% off.

•   Compare market rates: Research what other providers charge for similar services in your area. Websites like FAIR Health Consumer and Healthcare Bluebook can help you determine if a provider overcharged you for a service.

If the first person you speak with isn’t helpful, ask to speak to a supervisor or someone in the billing department who is authorized to make adjustments.

5. Negotiate a Payment Plan

Even providers who won’t budge on price are often willing to offer payment plans, allowing you to pay off your debt in smaller, more affordable installments. Here are some tips for how to approach setting up a payment plan:

•   Determine your budget: Before you ask about payment plans, it’s a good idea to look at your monthly cash flow and calculate how much you can realistically afford to pay toward your medical bill each month.

•   Propose a plan: A good negotiating tactic is to start by offering a lower monthly payment amount than you can afford, as this leaves room for negotiation.

•   Request interest-free terms: Many providers offer payment plans without added interest, making this option more affordable than making monthly payments on your credit card.

It’s a good idea to get the terms of your payment plan in writing to avoid confusion later. Sticking to the agreed schedule can also help you avoid additional fees or collection efforts.

Recommended: Can Medical Bills Go on Your Credit Report?

Employer Resources

Many employers offer benefits that can help reduce medical costs, such as health-related savings accounts (HSAs), health reimbursement arrangements (HRAs), and stipends. These resources can significantly reduce the financial strain of medical bills, so it’s worth exploring any options offered by your employer.

Possible benefits you might be able to tap:

•   Health Reimbursement Arrangements (HRA): Employers fund HRAs to help employees cover qualified medical expenses. You may want to check with your HR department to see if this benefit is available and how to access it.

•   Health Savings Accounts (HSA): If you have a high-deductible health plan, an HSA can be used to pay for eligible medical expenses with pretax dollars. This account can also be used to cover deductible costs, prescriptions, and certain treatments.

•   Flexible Spending Accounts (FSA): Similar to HSAs, FSAs allow you to use pretax funds for medical expenses, but they usually have a “use it or lose it” policy, meaning funds must be spent within the plan year. You’ll want to use your FSA funds strategically to cover eligible medical costs.

•   Health stipends: Some employers offer additional financial support in the form of taxable health stipends, which can be used for medical bills or health-related expenses. Contact your HR department to explore this benefit.

What to Do If You Can’t Negotiate Lower Medical Bills

If you’re unable to negotiate your medical bills to an affordable price and your employer doesn’t offer benefits like HRAs or stipends, you’re not necessarily out of options. Below are two ways you may be able to affordably finance your medical bills.

•   Personal loan: An unsecured personal loan can be used for virtually any purpose, including paying medical bills. Interest rates can be significantly lower than those of credit cards, particularly if you have strong credit. And unlike credit cards, personal loan rates are typically fixed, allowing you to pay off your debt on a fixed payment schedule. If you can qualify for a personal loan with a good rate and manageable monthly payment, you might use it to pay off your medical bills immediately and avoid accruing late fees or having the bill move into collections. A personal loan calculator can help you run the numbers.

•   Zero-interest credit card: If you have strong enough credit to qualify for a credit card with a 0% introductory rate, you may be able to put the bill on your card then make interest-free payments for 12 to 21 months. Additionally, some providers offer medical credit cards with interest-free promotional periods, which may be anywhere from six to 24 months. These can help you pay off large bills over time, but be cautious of high interest rates once the promotional period ends.

Recommended: Personal Loan vs Credit Card

The Takeaway

Medical bills can be overwhelming, but they aren’t necessarily the last word. You may be able to negotiate the amount due by requesting an itemized bill, checking for errors, exploring financial assistance programs, and simply asking for a lower bill. Other tools that can help make medical bills more manageable include setting up an interest-free payment plan, tapping employer health benefits, and taking advantage of low-interest financing options.

Think twice before turning to high-interest credit cards. Consider a SoFi personal loan instead. SoFi offers competitive fixed rates and same-day funding. See your rate in minutes.

SoFi’s Personal Loan was named NerdWallet’s 2024 winner for Best Personal Loan overall.

FAQ

Do medical bills affect your credit?

If the medical bill stays with your provider, it won’t impact your credit. If your payment is several months past due, however, the provider may sell your debt to a collections agency. Unpaid medical debt in collections (over $500) can be reported to credit bureaus after one year.

If medical debt does end up on your credit reports, it can lower your FICO® score. However, due to recent changes in how FICO calculates scores, medical debt generally has less impact on your scores than other types of debt.

Should I pay a medical bill that’s gone to collections?

Paying a medical bill in collections can protect your credit and resolve the debt, but you’ll want to first verify it’s legitimate. To ensure the debt amount is correct and has not already been paid, ask for documentation from the collection agency.

If the debt is valid, consider negotiating a reduced payoff amount or setting up a payment plan. Once paid, it’s a good idea to ask for written confirmation that the account will be marked as resolved. Under new guidelines, paid medical collection debt is no longer included in credit reports.

How long do I have to pay a medical bill?

The timeline to pay a medical bill varies depending on the provider’s policies. Many hospitals and health care providers expect payment within 30 to 90 days of issuing the bill and will charge late fees and/or interest if you miss the due date.

The statute of limitations — how long a provider or collection agency has to sue you for an unpaid medical bill — typically ranges from three to 10 years, depending on the state. However, the debt remains collectible even after that period.

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Non affiliation: SoFi isn’t affiliated with any of the companies highlighted in this article.

Financial Tips & Strategies: The tips provided on this website are of a general nature and do not take into account your specific objectives, financial situation, and needs. You should always consider their appropriateness given your own circumstances.

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Residency is an exciting opportunity to get in-depth training within your chosen medical specialty. But these years also come with challenges. Residents are typically required to work long hours while earning just a fraction of what licensed physician’s make. At the same time, you likely have living expenses to cover, plus a mountain of education debt to pay back. This leads many residents to consider medical moonlighting as a way to bring in extra income.

Moonlighting simply means working a second job in addition to a primary job. For residents, it can be a chance to not only earn extra money, but also gain experience in new settings and broaden your career horizons. But there are also some significant downsides to consider. Here’s what residents need to know about medical moonlighting.

How Does Medical Moonlighting Work?

Medical moonlighting essentially means working a second job as an independent physician while still being in residency. Residents often take on moonlighting jobs to supplement their salaries, pay down student loan debt, and to get additional experience and practice beyond their responsibilities in their residency program.

Many medical moonlighting jobs fall under the category of what’s called “locum tenens” jobs, where you substitute for other medical professionals that are out on leave or help provide additional coverage at hospitals that are temporarily short-staffed. Often, you are able to pick and choose shifts that work with your schedule.

While moonlighting might seem like the perfect solution to financial stress, the policies and restrictions on resident moonlighting can be tricky to navigate. While residents who are licensed physicians are legally allowed to take on jobs providing medical care, residency programs typically have their own policies on whether residents can take on extra work.

Some programs prohibit moonlighting entirely, while others might limit moonlighting to residents further along in the program. Many programs will require you to get prior permission from a supervisor before you start moonlighting and you may have to formally state your reasons and goals for moonlighting.

Some residency programs allow you to take moonlighting shifts at the hospital facility where you are currently working, but you may be restricted from taking work outside of your hospital network.

Also keep in mind that the Accreditation Council for Graduate Medical Education (ACGME) guidelines state that residents have an 80 hour weekly limit, on average, over each four-week period, with at least 10 hours of rest between duty hours. Plus, one of every seven days must be free of patient care duties and educational obligations.


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There Are Two Ways to Moonlight

There are two types of medical moonlighting that residents can pursue: internal and external.

Internal moonlighting involves working extra shifts at the hospital where you are primarily employed as a resident. External moonlighting, by contrast, means picking up extra shifts at a clinic, a practice, an urgent care center, or a different hospital than where you’re training.

External positions are usually locum tenens. Both residents and physicians can work locum tenens jobs, and residents often prefer these jobs to taking on an external part-time job with a single employer. For one reason, they provide flexibility and don’t require having an independent medical license (as opposed to a training license), your own malpractice insurance, or having privileges at a specific hospital.

Pros and Cons of Moonlighting in Residency

Medical moonlighting has benefits and drawbacks. Here’s a closer look at reasons for and against moonlighting in residency.

Advantages of Moonlighting During Residency

Earn Extra Income

Taking on a few moonlighting shifts per month can add up to substantial extra income — especially on a resident’s salary. As for how much money you can make moonlighting in residency, the answer will depend on the type of work you end up doing and the area you’re in. The average pay range is $100-$200 per hour, depending on the location and job duties.

Recommended: Guide to Medical Student Loan Refinancing

Gain Valuable Experience

You might be able to get experience that you don’t typically get in your residency program or you may get additional practice with certain skills or procedures. The extra hours in another area of the hospital — or in another hospital nearby — can give you insight into how other units operate.

The more experience you get, the more robust your resume will become. A great resume can lead to more job opportunities in the future.

Test Out Different Practice Settings

There are many types of workplaces physicians can choose to work in. Moonlighting offers the opportunity to test out some different settings, such as group practices, private practices, urgent care centers, and community clinics.

When your residency ends and it’s time to find a full-time job, having experience in more than one healthcare setting may help guide you toward (or away from) certain types of workplaces.

Expand Your Network

Moonlighting can provide the opportunity to work with more professionals in your field. If you choose external moonlighting, you may be able to develop relationships with physicians, residents, administrators, and other healthcare providers who you wouldn’t otherwise meet in your residency program. Expanding your network can expand your future career opportunities.

Disadvantages of Moonlighting During Residency

Less Free Time

As a resident, you’re likely already working long hours on a grueling schedule while also trying to hone your skills in your chosen specialty. On top of your current workload, even an extra shift here and there can mean you lose out on time with friends and family — or precious sleep.

More Stress

Taking on too much work can lead to mistakes and high stress levels. If you’re earning extra cash now but the quality of your work in your residency is compromised, moonlighting might not be worth it for you. As a resident, your first job is to learn, practice your skills, and build a foundation for your career. It can be a bit of a balancing act.

Medical Malpractice Coverage

With an internal moonlighting position, you’ll work under your training license and have liability coverage and protection under your residency program’s malpractice policy. But external moonlighting might require you to purchase a pricey professional liability insurance policy that you may or may not be able to afford.

Some locum tenens staffing agencies provide malpractice insurance but you’ll want to make sure the coverage is sufficient.

Could Raise Your Monthly Loan Payments

If you’re paying back your student loans on an income-driven repayment (IDR) plan, moonlighting can increase your monthly payments. Under an IDR plan, you pay a percentage of your income. The more income you earn, generally the higher your payments will be.


💡 Quick Tip: Refinancing could be a great choice for working graduates who have higher-interest graduate PLUS loans, Direct Unsubsidized Loans, and/or private loans.

How to Start Moonlighting in Residency

So, you’ve weighed the pros and cons, looked into your program and institution policies, and want to move forward with medical moonlighting. How do you find moonlighting opportunities?

If your hospital offers internal moonlighting shifts, that can be a good place to start your search. Internal moonlighting lets you work under your existing training license and malpractice insurance coverage.

If internal shifts are not available or you prefer to work external positions, you can find them through locum tenens staffing agencies. You can also find moonlighting opportunities through online job boards, such as:

•   Moonlighting.org

•   ZipRecruiter

•   Indeed

•   ResidentMoonlighting.com

Moonlighting jobs are available for physicians that work in a variety of medical specialties. It’s just a matter of finding ones available in your area. You might also consider using moonlighting as an opportunity to work in a more generalized specialty, like internal medicine, rather than looking for positions in their more specialized field.

The Takeaway

Moonlighting as a resident can help you earn extra money and start paying down medical school debt, while also gaining more practical experience. But before you start moonlighting in residency, you’ll want to make sure your medical school allows it. You’ll also need to monitor your working hours to ensure you’re following the ACGME 80-hour work week policy. Any internal or external moonlighting you do will be considered part of that 80-hour work week.

If you decide to move forward with medical moonlighting, you can start exploring your options and looking for a moonlighting gig that you think you’ll enjoy, that pays well, and that continues to give you more experience.

Looking to lower your monthly student loan payment? Refinancing may be one way to do it — by extending your loan term, getting a lower interest rate than what you currently have, or both. (Please note that refinancing federal loans makes them ineligible for federal forgiveness and protections. Also, lengthening your loan term may mean paying more in interest over the life of the loan.) SoFi student loan refinancing offers flexible terms that fit your budget.

With SoFi, refinancing is fast, easy, and all online. We offer competitive fixed and variable rates.

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SoFi Loan Products
SoFi loans are originated by SoFi Bank, N.A., NMLS #696891 (Member FDIC). For additional product-specific legal and licensing information, see SoFi.com/legal. Equal Housing Lender.

Non affiliation: SoFi isn’t affiliated with any of the companies highlighted in this article.

Financial Tips & Strategies: The tips provided on this website are of a general nature and do not take into account your specific objectives, financial situation, and needs. You should always consider their appropriateness given your own circumstances.

Third-Party Brand Mentions: No brands, products, or companies mentioned are affiliated with SoFi, nor do they endorse or sponsor this article. Third-party trademarks referenced herein are property of their respective owners.

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