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How To Negotiate Medical Bills

By Kim Franke-Folstad · December 20, 2022 · 10 minute read

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How To Negotiate Medical Bills

In 2020, the average health insurance deductible was $4,364 for individuals, and a staggering $8,439 for families. (Thanks a lot, high-deductible health plans.) That’s a lot to pay upfront before insurance kicks in. What many people don’t know is that the medical bills you receive aren’t always set in stone. You may be able to work with the hospital, doctor, or ambulance service to negotiate a lower price.

We’ll explain how to research your medical bills, dispute overcharges, and negotiate a more fair and affordable price.

Preparing for Medical Bill Negotiation

Save Your Explanation of Benefits

Soon after you’ve received medical care, you should receive an explanation of benefits (EOB) from your insurance company. It may look like a bill, but it isn’t — it’s a breakdown of the following:

•   Medical services you were provided

•   What the doctor or hospital charged

•   What your insurance covered (and didn’t cover)

•   How much your insurance agreed to pay

•   The amount you’re expected to pay

The EOB 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(s) you receive. Your EOB may even 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. If you’re confused or suspect an error, call the number listed on the EOB to get help.

Be sure to save your EOB when it comes in the mail, or download it when you receive an email that it’s ready. You may need it when you speak to your insurance company or doctor.

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Be Clear About Who’s Billing You

One visit to the emergency room can result in multiple medical tabs. You might be billed by the ambulance, the hospital, and the specialist who saw you.

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

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

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 — get in touch with the provider who sent it.

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

Ways To Negotiate a Medical Bill

Can you really negotiate medical bills? Absolutely, and there are a few different strategies you can adopt when talking down healthcare costs. If one tactic fails, don’t give up — simply move on to another. The most effective method for negotiating a hospital bill may depend on your situation and the doctor. Here are a few to consider:

Ways to Negotiate Medical Bills

Dispute Any Errors

Errors on medical bills are surprisingly common. Look for things like duplicate charges, charges for procedures that didn’t happen, errors in your insurance information, mistakes regarding whether a provider was in-network or out-of-network, and misstated quantities of medications and supplies.

Billing codes for diagnoses and treatments can also be entered wrong, which can confuse the insurance company and slow down or stop payment on a bill. If you suspect your bill was miscoded (and you’re feeling motivated), you can look them up online. There are two different databases:

•   Diagnosis codes, called ICD codes (for International Classification of Diseases) can be found on the Centers for Disease Control website.

•   Treatment and service codes, called CPT codes (for Current Procedural Terminology), are available on the Centers for Medicare and Medicaid website. Just accept the usage waiver, and a spreadsheet of codes will download automatically.

A billing representative can answer almost any 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.

Offer To Pay a Lump Sum

Many hospitals 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.

Show 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 can also cite the amount Medicare allows for the service. Frame your request as a desire to pay what is “usual, customary, and reasonable”

Negotiate 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 negotiate a payment plan doesn’t mean you shouldn’t try asking for a discount on the total as well.

Research Hospital and Government Resources

When you’re sick or recovering, online research and phone calls can exhaust your limited energy reserves. But 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 and for uninsured patients. 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. You can check your eligibility on Medicaid.gov

Ask for an Advocate

When you need additional help negotiating with your insurance company or medical provider, consider a patient advocacy organization, such as the Patient Advocate Foundation at PatientAdvocate.org, or state or local consumer protection agency at USA.gov/State-Consumer

Come Prepared To Negotiate

If you’re new to negotiating, here are some basics that can 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 them to understand your situation and can improve the chances that 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 with a little online searching or by consulting resources like HealthcareBluebook.com

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 ignoring 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.

Borrowing Money 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.

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Credit Card

Using a credit card to pay medical bills is not generally recommended because of their typically high-interest rates. However, if you have 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 see your credit score drop.

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Personal Loan

Another option you might consider is taking out an unsecured personal loan to pay your medical bills. Personal loans interest rates can be significantly lower than those of credit cards, particularly if you have a healthy credit score. And since a fixed-rate 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 a 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. SoFi’s personal loan calculator can help you run the numbers.

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The Takeaway

Medical bills can be stressful, especially when added to the stress of having medical treatment. 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 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.

Pay for medical costs — without sinking into high-interest debt.

FAQ

Do medical bills affect your credit?

As long as your medical bill remains with the original doctor or facility, it won’t show up on your credit report. But if the bill goes to collections, it can affect your credit score.

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

Yes, paying off medical collections will remove the negative information from your credit report and help you build up your credit again. Under new guidelines, paid medical collections will no longer remain on your report.

How long do I have to pay a medical bill?

Medical bills are typically due 30 days from the date of the bill. Doctors and facilities usually send several rounds of bills before turning the debt over to a collections agency. If you’re struggling to pay your medical bills, call the doctor or facility to negotiate either a lower price or a payment plan that you can afford.


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