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How to Negotiate Medical Bills

By Kim Franke-Folstad · September 21, 2021 · 8 minute read

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How to Negotiate Medical Bills

Facing a staggering medical bill can feel overwhelming, but if you find yourself struggling to pay, don’t give up hope. You may be able to work with the hospital, doctor, ambulance service, or other health-care provider to negotiate a lower price tag. The costs involved aren’t always set in stone, and there might be some wiggle room if you just ask.

Here are some things to consider as you work your way through the negotiation process.

Preparing for Medical Bill Negotiation

Save Your Explanation of Benefits

A few weeks after you’ve received medical care, you should receive an explanation of benefits (EOB) from your insurance provider. It may look like a bill, but it isn’t—it’s a breakdown of recent medical services you were provided, what the doctor or hospital charged, what your insurance covered (and didn’t cover), what your insurance company agreed to pay your providers, and the amount you’re expected to pay.

This document can help you be sure you’re receiving the full benefits to which you are entitled under your insurance plan. And it can be useful to compare the information your insurance company has to the actual bill (or bills) you receive.

Your EOB also may offer a better description of the services you received than what’s on your medical bills.

If your EOB seems incomplete, it may be because it doesn’t reflect the most recent charges or payments made to or by your insurance provider. If you’re confused or if there seems to be an error, you can call the number listed on the EOB to get help.

Be sure to save your EOB when it comes in the mail. You may need it when you speak to your insurance company or your health care provider.

Be Clear About Who’s Billing You

It can be confusing when medical bills start showing up in your mailbox. For example, you might be billed by several different providers (the hospital, a specialist who saw you, or the ambulance, for example) for just one visit to the emergency room.

Adding to the complexity, the invoice you receive may come from a provider’s internal billing department, or it might come from a company that’s been hired to handle all invoicing and payments for a hospital, physician, or physician’s group.

To avoid mix-ups, it can be useful to carefully track who sent each bill as it arrives, to note if the billing was outsourced or done in-house, and to mark down who you’ve talked to about errors or making payments. Don’t forget to keep a copy of your EOB with those statements so you’re always prepared with the information it contains.

Don’t Delay Getting Help

As soon as you realize there’s a problem with a bill—either because it’s incorrect or it’s just too high for you to manage—it’s a good idea to get in touch with the provider who sent it.

As long as your medical debt remains with the original service provider, it won’t show up on your credit report. But if the bill goes to collections, it could eventually affect your credit score. You also may have fewer options for negotiating once the debt goes to collections.

Ways to Negotiate a Medical Bill

Can you negotiate medical bills? Absolutely, and there are a few different strategies you can adopt when negotiating a medical bill. If one tactic fails, you don’t have to give up—you can simply move on to another. The method that works effectively for how to negotiate a hospital bill down may depend on your situation and the provider. Here are a few to consider:

Ways to Negotiate Medical Bills

Disputing Any Errors

Errors on medical bills are surprisingly common. Look for things like duplicate charges, incorrect billing codes, charges for procedures that didn’t happen, errors in your insurance information, mistakes regarding whether a charge was in-network or out-of-network, or misstated quantities of medications. The provider’s billing representative can answer questions you have regarding your bill, so don’t hesitate to ask what certain line items are. If you catch any errors that inflate your bill, you may want to file a dispute to get the charges reduced or eliminated.

Offering to Pay a Lump Sum

Many hospitals would prefer to get a slightly lower payment at the time of billing than wait for a bill to drag through collections. You can offer to pay the bill immediately—ideally in cash rather than by credit card—if the provider will accept less than the total amount due.

A good rule of thumb is to start high when suggesting a discount, leaving room for the provider to negotiate downward. It’s perfectly reasonable to start by requesting a 50% discount. Even if you don’t pay the entire bill at once, ask whether the provider offers a self-pay discount for those paying out of pocket.

Showing Evidence of Overcharges

This is where doing your homework comes in handy. If you can show evidence that you were charged more than the average price points in your area, you may have leverage for requesting a discount on your bill. Besides checking online resources and calling competitors, you also can cite the amount Medicare allows for the service. Consider framing your request as your desire to pay what is usual, customary, and reasonable .

Negotiating a Payment Plan

Some facilities will agree to a payment plan that replaces the original bill’s due date with a schedule that’s feasible for you. See if you can sign on to a plan with zero interest. If that’s not an option, you can try asking for a lower interest rate. And just because you’ve negotiated a payment plan doesn’t mean you shouldn’t try asking for a discount on the total as well.

Researching Hospital and Government Resources

If you’re struggling, you don’t have to go it alone. There are several resources you may be able to tap for assistance.

Hospital Help

Hospitals often offer discounts or financial relief programs, such as forgiveness, for patients whose income falls below a certain threshold or for those who are uninsured. The hospital may refer to this help as “charity care,” “bridge assistance,” or simply “financial assistance.”

Even if you don’t meet income guidelines for government programs, it’s worth checking on what’s available at the hospital level.

Government Financial Assistance

If you weren’t on Medicaid but would have qualified for it when the original medical charges were generated, you may be able to get retroactive help. Depending on the state you live in, Medicaid (a federally authorized, state-administered insurance program for low-income individuals), may cover bills received up to three months before the month you apply for the program.

Ask for an Advocate

If you feel as though you need additional help negotiating with your insurance company or medical provider, you may want to contact a patient advocacy organization, such as the Patient Advocate Foundation , or state or local consumer protection agency .

Come Prepared to Negotiate

If you’re new to negotiating, here are some basics that could help:

Try to Stay Calm and Polite

Do your best to keep your emotions under control while communicating with billing department representatives. Expressing your requests in a clear and collected way will make it easier for the provider to understand your situation and could improve the chances the representatives you deal with will want to help. If you’re angry or despairing, cool off before picking up the phone.

Do Your Homework

You may have a better chance of succeeding if you’ve researched the average costs of the treatments you received—especially if you use data that’s specific to your area. You can find this information by contacting competitors, with a little online searching, or by consulting resources like Healthcare Bluebook .

Insurance Terms to Know

Don’t Underestimate the Power of Empathy

Explain economic or other hardships you’re facing and why you’re struggling with repayment. Perhaps you’ve recently lost your job, or you just got out of college and you’re on your own for the first time. Calling on the other person’s sense of compassion and humanity may help your cause.

Write Down Everything

Keep clear notes with the dates, names, and affiliations for every phone call you have, as well as reference numbers if applicable. It’s easy to forget what you spoke about and with whom. Keep everything in one place. And ask to receive the final details of any agreement you make in writing.

Don’t Hesitate to Escalate

Start with the contact phone number on your bill. But if the person you’re speaking with seems unwilling or unable to help, don’t be afraid to ask for a supervisor. Be prepared to explain the situation, over and over again, to each person you speak with.

If all else fails, apply a bit of pressure. While remaining courteous, state that you probably won’t use this provider or facility again if they can’t meet you halfway. Mention that you’ll share your negative experience with your network, including on social media.

What Happens If You Don’t Pay Medical Bills?

The worst thing you can do with overwhelming medical bills is ignore them. If you don’t make a payment by the due date on your bill, what happens next depends on the laws in your state.

After a few months, if you still haven’t paid, the hospital may pass your bill on to a debt collections agency, and that agency may report the past due balance to the credit bureaus that put together your credit reports. From there, individuals with medical debt have about six months to fix insurance or billing problems. Once that grace period is over, however, an unpaid bill can impact your credit score for years. And if a court issues a judgment in the hospital’s favor, your wages could be garnished. This means money could be taken directly from your paycheck and sent to the creditor, even without your consent.

Taking on Debt to Pay Medical Bills

Even if you use all the strategies described above, negotiation doesn’t always work. If you can’t get your bill reduced or eliminated by negotiating, there are other options, such as taking on debt by using a credit card or taking out an unsecured personal loan.

Using a credit card to pay medical bills is not generally recommended because of credit cards’ typically high interest rates. However, if you’ve exhausted all negotiating tactics and are still having trouble paying your outstanding balance after the six months’ grace period given by credit reporting agencies, it might be better to pay the balance with a credit card than to have your account sent to collections and have an adverse affect on your credit score.

Another option that might be considered is taking out an unsecured personal loan to pay the medical bills. Personal loans’ interest rates can be significantly lower than those of credit cards, particularly if you have a healthy credit score. They can be used for many purposes and since a fixed-rate, unsecured personal loan is installment debt—in contrast to the revolving debt of credit cards—the balance is paid on a fixed payment schedule.

If you qualify for an unsecured personal loan with a manageable interest rate and monthly payment, you can use it to pay off your medical bills immediately and avoid accruing late fees or having the bill move into collections.

The Takeaway

Medical bills can be stress inducing, especially when added to the stress of having medical treatment to begin with. But it’s best not to ignore them. Armed with the right tactics, you may be able to negotiate the amount due or get assistance to make the expense manageable. If that doesn’t work, a SoFi personal loan may be another option to look into so you can prevent medical bills from dragging you into a vicious cycle of debt.

An unsecured personal loan from SoFi offers competitive, fixed rates; no fees; and loan terms that can work with a variety of budgets.

Looking for a way to deal with unmanageable hospital bills? Check your rate for a SoFi Personal Loan to get started managing your medical debt.

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