How to Best Prepare Yourself for Negotiating Medical Bills

Healthcare Writer

Updated on: August 22nd, 2020

Reviewed by Kim Buckey

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When you have a medical emergency, the last thing you want to think about is how much it’s going to cost to receive treatment. But getting slammed with medical bills during recovery is a reality for most patients. A word of caution – check those bills carefully. 

Do you know that up to 80% of medical bills contain errors? Or that 60% of Americans have been surprised by a medical bill they thought their plan would cover?

According to federal law, hospitals must treat you in an emergency, regardless of which insurer you have or whether you even have insurance. Just know that you will receive bills for those services. Your next step, you may want to try negotiating those bills. 

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Fortunately, there are some things you can do to give you the best possible chance to lower your health care costs. To help you prepare for your negotiation, we break down the necessary steps that you should take before, during and after receiving medical treatment.

Key Takeaways

Plan your treatment. Know your doctors and costs. Keep track of what’s happening and take notes while at the hospital.

Have a plan to deal with mistakes on your bill or any errors.

If you run into a wall and negotiating fails, don’t be afraid to seek help.

What Should You Do Before Receiving Treatment?

If you know ahead of time that you will need a procedure, therapy or test, discuss the service you will be receiving with your doctor. Ask who will be involved with your care and try to get an estimate of costs. Find out which providers are in and out of your network and be sure to ask that any doctors that will be treating you are in-network, if possible. 

What Should You Do As You Receive Treatment? 

Focus on Medically Necessary Services  

Think about ways to minimize your bill as you are receiving care. If you’re feeling up to it, remind your provider you want in-network care, which means doctors and other clinicians who are covered by your insurance company. 

Understandably, medical debt is a big concern, but recovery is your first priority so don’t spend a lot of energy obsessing about reducing your costs at this point. Manage costs if you can do so easily, but prioritize getting the immediate care you need. You won’t save any money if you make your health issue worse.  

Write Down Everything That Happens

To the extent possible, write down basic information about the care you receive and the doctors that you see. Taking notes makes it easier to remember at a later date what treatment you received; more importantly, keeping this record makes it easier to negotiate medical bills later.

You can take notes during your hospital stay or doctor’s appointment. If you’re in a hospital for a long period of time, you can ask for a pen and paper. If you’re discharged after a short time, you can write down what happened after you leave. You can even use your phone.

If you are unable to take notes yourself, ask a family member or friend to do it for you. You want to keep track of any tests you receive and when you have them. Also, always ask for the business card of any doctor or specialist who sees you.

Create a Timeline of Actions & Names: If you have a timeline of actions and names, you’ll be able to explain your bill to others instead of having costs explained to you. This allows you to direct the discussion, giving you a significant advantage when contesting your medical costs.

What Should You Do After Getting Care?

Get an Itemized Bill

If costs matter to you, you’ll need to closely examine your bill. This can’t really be done at the moment you’re being discharged from the doctor’s office or hospital.

Request an Itemized Copy of Your Hospital Bill: Once you’re discharged, you should request an itemized copy of your bill, along with any other financial information your doctors can provide. You don’t have to pay right away, but you will need to take action.

If you received care in the emergency room, ask the hospital what “level” of care you received. Hospitals “code” care in terms of severity; you’ll want to make sure the level aligns with the actual care you received.

There are a number of coding errors made in the heat of the moment that typically go unchallenged by hospitals and insurance companies. Maybe you’re paying separately for a service that should be part of a less expensive package. Maybe the bill you received is simply incorrect. You won’t know until you see the document.

Don’t Pay Right Away; Check Your Bill for Errors

Start by reviewing your bill against your notes. Flag any charges that don’t line up with what you have listed, including tests you don’t remember receiving, anything that appears to be a duplicate, provider’s names you don’t recognize, etc. Were you billed for medications over your entire stay even though you only took them once or twice? Are there charges for consultations with specialists that you didn’t see? If you had a baby, were you billed for nursery care when you kept the baby in your room?

Keep in mind that some providers send out “service bills” while they are waiting for insurance payments. This is vitally important – wait until you receive your actual bill, which shows specific charges, any adjustments that were made, payments made by you and/or your insurance company, and a balance due – before you pay anything. 

Compare Your Bill with Your Policy’s Explanation of Benefits: If you’re insured, don’t pay any bills until you receive the statement your insurance provider will mail to you (also called an explanation of benefits) showing what charges are allowed and what the insurance company paid. Compare this statement with the bills you receive.

Make sure the dates and descriptions of services are accurate, and the CPT (procedure codes) on your EOB match the ones on the bill(s) from your provider(s). Check the notes section on the EOB for any explanations of why a charge was not covered (if applicable).  You have the right to appeal a denial if you disagree with the decision; it may just be due to an easily-corrected error.

Compare Any Subsequent Bills to Your Notes and EOBs

Often you will receive bills from individual providers–for example, from the surgeon, radiologist, anesthesiologist, etc.–in addition to your hospital bill. Be sure to compare these to your notes and the EOB; make sure these providers have submitted their invoices to all your insurance plans. 

While comparing your notes to the bills you receive, keep in mind that sometimes tests are ordered and billed, but for some reason, you never had the test. Or you may have refused a medication that you will see on your bill. 

Keep All Your Documents

You’ll never know where the fine print will lead, when it will contradict your bill, or who will offer to help pay. Having information handy will keep you grounded and get any of your advocates (including friends, family, or outside support) up to speed.

Even if your hospital wants to help, it’s not easy to request information from multiple doctors and departments. Keeping your own records will help make sure you and the hospital on the same page. In the end, you’ll need to rely on your own documentation.

How Should You Negotiate Medical Bills?

If there’s a mistake on your bill, or it doesn’t show the expected payment from your insurance plan, it helps to have a plan.

The best place to start is usually by calling the provider’s billing office.  Explain the situation calmly and politely; most will be willing to work with you to correct the error. If your bill doesn’t include payment from the insurance company, make sure the provider has the correct insurance information for you.

Always document all in-person and phone conversations with the name of the person you spoke to, the date and time of the conversation and a summary of what was discussed. 

If you need to negotiate your bill, for example if you receive a balance bill or a bill you can’t pay in full, be sure to act quickly. You don’t want this debt to affect your credit score.

How Do You Protect Yourself?

Make Sure You Leave a Paper Trail: If you’re verbally given a payment offer or other important information, make sure to get it in writing (if it’s not in writing, it doesn’t exist). You can email summaries of conversations back and forth to create a paper trail.

Take Note of Your Bill & Debt Collectors: When you’re contesting your medical costs, it helps to take notes about your bill, and to note the people you’ve spoken with about what you owe. Debt collectors can be penalized for using unfair tactics if you catch them making threats or calling at odd hours.

What Are Negotiating Tips?

Gather your ammunition. Have your notes, itemized bill, EOB and any other documentation you need in front of you. Your next steps depend on what you need to accomplish.

  • If you’re negotiating a balance bill from an out-of-network provider, call your insurance company and ask for the market rate (e.g., what they would have paid an in-network provider) for that service.

Then call the provider’s billing office and ask if it will accept the in-network price as payment in full. Use your research about the market rate as leverage.

  • Offer to pay cash, if you can. This saves the provider the credit card processing fee.You may even be offered a discount if you pay cash.
  • Ask to set up a payment plan. Set your own terms, even if you‘ll be paying over a longer period of time. Never agree to pay more than you can afford monthly–missing a payment reduces your negotiating power and may result in your account being turned over to a collection agency.
  • If a payment plan isn’t an option, request a financial hardship application.

Remember, providers would prefer to receive some payment than no payment at all. However, if your provider is uncooperative, tell them you will file a complaint, either with the insurance company, your state medical board, your state health services department or your state Department of Insurance, whichever agency is applicable.

Where Can You Get Help with Medical Bills?

Ask a Patient Advocate or Someone You Trust

You may want to check with your employer — or insurer — to see if they have a patient advocate program available. Advocates are trained professionals who understand health care and the ins and outs of insurance, and can help you resolve billing errors and negotiate payments. Another alternative is to hire an independent advocate. One such resource can be found here: https://www.nahac.com/find-an-advocate#!directory/map.

Go to Someone with More Power – Your State or Hospital Ombudsman

Many hospitals and medical groups will have a semi-independent position known as an ombudsman. Their job is to review the quality and necessity of your care.

They might be listed on your bill, and may be able to influence what you’re being charged. Your state department of health may also have specific resources for challenging exaggerated costs of care, and the institutional knowledge of who to contact at your specific hospital.

If your income prevents you from getting charity care, an ombudsman could be a good option. He/she may help you at least find a sympathetic ear.

Take Precautions When You Can 

Medical debt is a leading cause of bankruptcy filings in the United States. If possible, before seeking care for a medical condition, look at all the options available to you and make sure you’re following the most affordable path.

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