5 Tips For Negotiating Medical Bills

Millions of Americans struggle with medical bills every year, even if they have health insurance. For many, medical bills turn into medical debt that increases over time because of the high interest rates attached to the debt.

One of the most common questions from Americans struggling with medical debt is, can it impact your credit score? The answer is unfortunately yes, it can. So, it’s important to manage medical debt early on. What many people don’t know is that you can actually negotiate some of your medical bills down, which will decrease the chances of having to deal with medical debt down the road. Below are some tips for how to do this…

1. Make Sure You Aren’t Being Overcharged

Check For Medical Billing Mistakes

Dealing with hospital bills and difficult insurers is hard enough. Unfortunately, you might also have to deal with billing errors. Hospital billing departments can sometimes make mistakes in their billing, including double charging for a service, entering an incorrect service code, or failing to add that the treatment was medically necessary. These kinds of mistakes can lead to much higher bills or lower insurance coverage.

Make sure to review the detailed bill (usually called the itemized bill) and ask questions if you don’t understand what a particular charge is. You may catch a mistake. If there are errors on the bill, ask the hospital to remove them.

Check Your Health Insurance Limits And Network

If you have health insurance, understand the limits of your insurance and what it does and doesn’t cover. For example, many health insurance companies will only cover treatments that are considered medically necessary. So, if you decide to undergo an optional surgery, your insurance may not cover any of the related medical bills.

If you’re not sure what your insurance will cover, you can always ask for your “explanation of benefits,” which is a packet of information about your insurance benefits. You can also call your insurance company prior to receiving a given treatment and ask them whether your plan covers it.

In addition to understanding your insurance limits, you’ll also want to understand which health care providers are considered “in-network” or “out of network.” Each insurance company has a list of medical providers who are considered “in-network providers.” Health insurance will cover more of your medical costs when you go to a medical provider who is in-network. In many cases, insurance won’t cover any of the costs related to out-of-network treatment. This means you’ll be on the hook for the entire bill.

Before accepting treatment, make sure every provider you see is covered by your network. This is something you should be able to confirm ahead of time by either calling the number on your insurance card or using your health insurance company’s online portal.

2. Ask Your Providers What Financial Assistance Programs They Offer

Many healthcare providers and insurance companies offer programs to help offset the cost of medical bills. 

Lower Prices For Preventive Care

Some providers offer packages for preventive care at affordable prices for people without health insurance. Preventive care can include:

• Diabetes, blood pressure, or cholesterol tests

• Routine cancer screenings such as mammograms and colonoscopies

• Vaccinations

• Flu shots

• Well-child visits

Charity Care And Community Care Programs

Many providers offer payment plans or discounts to people who are experiencing financial hardships caused by job loss or other circumstances. These programs are often a part of charity care or community care programs.

Whether you qualify for assistance with your hospital bills through a charity care program will depend on your situation, your income level, and what state you live in. Different states have different laws that govern charity care programs. 

Unfortunately, some service providers will try to avoid giving you the assistance you need through a charity care program, even if your medical procedure was an emergency. If this is the case, there are nonprofit lawyers, medical billing advocates, and patient advocate foundations that can help you with your medical bills. If you need help finding assistance, call your local department of health services, or try Googling "patient care foundation" alongside the name of the city or county you live in.

Lower Prescription Costs Through Generic Medications

Generic brands exist for many different types of medication, including prescription drugs. Ask your provider and pharmacist to see if generic options exist for any medication you’ve been prescribed. Some pharmaceutical companies also have programs that assist patients struggling to pay for specific medications, regardless of whether these medications are generic or not. 

3. Negotiate The Dollar Amount With Your Provider

Different hospital systems charge different rates for their services. Some hospitals and other healthcare providers charge above-market prices, which means they’re overcharging for certain treatments or medications.

 You can research the local prices of any medical service you may need. For example, if your doctor orders an MRI, you can research the MRI providers in your area and request quotes from each instead of getting the MRI at the hospital where your doctor works. Then, you can ask your doctor to send the order to that provider.

If you’ve already received medical care, you can still negotiate your medical bill with your provider's billing department by researching the current market price for the treatment and asking your provider to give you that price. If you're not sure what the market price is for any treatment, you might be able to check using the Healthcare Bluebook, which is sometimes made accessible by health insurance providers.

Here are a few other strategies you can use to negotiate your medical bill:

• Pay Upfront for a Discount: Hospital billing departments are sometimes willing to give you a discounted rate for treatment if you pay the entire amount of the treatment or your copay upfront. While some providers will offer this option when you check in for your appointment, others won’t disclose that they have a discount policy for upfront payments. Make sure to always check with your provider about discounted rates before your appointment.

• Disclose Financial Hardship: Most providers would rather get something than nothing. If you declare bankruptcy and discharge the medical debt, your provider will get nothing. Because providers are aware of this possibility, some will offer to lower your medical bill if you disclose that you’re experiencing financial hardship.

• Disclose What You Can’t Pay: Going through a financial hardship like job loss, mounting debt, or bankruptcy is extremely stressful. If you’re struggling financially, it’s important to be realistic with your provider about what you can and can’t pay. If you’re honest with them about what you can’t pay, they may give you alternatives to help you settle your medical debt.

4. Seek Government Assistance

State and local services may have programs to help you pay for medical care and/or lower your medical bills.

As mentioned above, many providers have charity care or community care programs. State laws often govern what kind of assistance providers must include in their charity care programs. If you’re not sure what options you have under a particular provider’s program, you can either talk directly with the provider or call your state’s department of health services to request information.

There are also other laws that have created federal benefits to help pay for medical bills. These include the Affordable Care Act, Medicare, and Medicaid. How much assistance you qualify for and what you will need to pay out of pocket will depend on your income level - including how many dependents you have and who else is earning money in your household - and also your assets. Assets include anything you own of value, like a home or a car. Lesser personal possessions, like your clothes and jewelry, are generally not considered “assets” under these laws.

Coverage Under The Affordable Care Act

If you don’t have health insurance, you can seek coverage under the Affordable Care Act (ACA). The ACA is a federal law that, among other things, changed many aspects of government-provided medical assistance, including aspects of Medicaid and Medicare. Its purpose is to make health insurance available to more Americans.Through the ACA you can apply for insurance online at healthcare.gov.

Medicare Vs. Medicaid

Medicare and Medicaid are programs that provide financial assistance for medical care to certain populations in the United States. Unlike the ACA, Medicare and Medicaid programs aren’t designed to help just anyone. Eligibility for these programs is determined based on age, disability, or income level.

Medicare: Medicare is healthcare coverage available to people age 65 and older, and also individuals with certain disabilities. It’s paid for by working individuals through their federal taxes. Medicare will help you pay your medical bills, but if you qualify, you’ll likely still have to pay a premium.

Medicaid: Medicaid is healthcare coverage available to people in need. Unlike the ACA, Medicaid programs are run by state governments, which set their own eligibility requirements.  As a general rule, low-income individuals, pregnant individuals, parents of a minor, and individuals with disabilities are eligible for Medicaid.

5. Taking Out A Loan To Pay Medical Bills

Although this might be the last resort, you can take out a personal loan or use a credit card to pay off your medical bills. This will keep the bill from moving into collections, which is a process that can impact your credit score. Even though paying your medical bill with a personal loan will prevent it from going to collections, you’ll still have debt…

So, if you do need to take out a personal loan or pay medical bills with a credit card, make sure you understand the terms of the loan, including:

• Fees: Some companies charge fees for cardholders who don’t make monthly purchases. If you’re taking out a credit card just to pay your medical bills, try to find a card that doesn’t have any associated fees. The same goes for opening new checking accounts - certain banks will charge you fees for not using the account enough.

• Costs and minimum balances: If you go to a new bank to get a loan or credit card, you may be required to pay money to open an account or take out the loan. A minimum account balance may also be required. For example, Chase Bank requires that all new bank accounts have a minimum of $300 deposited at the start.

• Interest rates: Both credit cards and personal loans will add interest to your debt. You’ll want to search for the lowest interest rate possible. You may be able to find a credit card that offers good rates for patients. Ultimately, you’ll want to find a loan or credit card that has an interest rate lower than the interest rates attached to medical debt that has gone to collections.

If you’re not sure where to start or which bank to go to, you can ask your healthcare provider for a recommendation.

Remember: if you decide to pay off medical bills in this way, you’re not getting rid of any medical debt, you’re just moving it to a new lender so you can create a payment plan with a reasonable monthly payment. This way, you'll avoid having to deal with a collection agency. Still, make sure that the payment plan works for you so that you don’t end up just pushing the debt down the road. Credit card debt can be just as bad for your credit report as medical debt.

Let’s Summarize...

If you have medical bills that you don’t think you can pay, seek assistance from your provider and/or from the government. There are resources available, but you have to have a strategy for dealing with medical debt. Even if you’re not sure whether you qualify for certain programs or government benefits, be upfront with your provider about your financial situation, as they may be able to work with you to lower the amount that you owe or provide you with some recommendations for how to pay your bill.

And lastly, remember that medical debt can often be discharged in bankruptcy, giving you the debt relief and breathing room to move on with your life. If you’d like to learn more about bankruptcy, visit our learning center, or get started with our free bankruptcy filing tool.