Negotiating Medical Bills

As everyone faces rising out-of-pocket healthcare costs, many wonder how to find the best prices for medical care and negotiate payment on existing medical bills.

Fortunately, there are several ways to negotiate how much you end up paying for medical services. Some of these, such as getting a second opinion or requesting financial aid, should occur before receiving treatment.

Others, such as setting up a payment plan, can be arranged after you receive your medical bill. If you find yourself struggling to pay your medical bills, do not be afraid to ask for help.

Doctors and hospitals would rather receive payments over time than not be paid at all. Review the following sections for tips on how to negotiate medical bills.

Know What You’re Paying For

Medical bill coding can be very complicated to understand, but it can have a big impact on how much you end up paying for medical services.

For example, your doctor may order an x-ray during an office visit, but its cost may not be included in your co-payment even if the x-ray is taken at the same facility that day.

Closely examine all bills you receive from doctors and hospitals and question any charges that you may feel are invalid. For example, if you scheduled a sick visit but asked your doctor about a chronic medical condition during that appointment, he or she may bill you an additional fee for the minutes spent on that off-topic consultation.

While this may not seem fair to you, most doctors and insurance companies consider it a legitimate charge. Others may be willing to remove it from your bill.

When you are hospitalized, always keep track of every procedure or medication you receive. When it’s time to check out, ask for an itemized bill and compare it to your notes. If you find inconsistencies, address them with the billing department.

Financial Aid

Nearly all hospitals have financial aid programs for qualifying individuals, but they rarely volunteer this information. If you need financial aid, you must ask for it. Search online for the hospital’s name coupled with “financial aid,” “financial assistance” or “charity care.”

Most hospitals determine financial aid eligibility by using the current federal poverty level, but many will also take into consideration your other expenses if your income falls above that mark.

In most cases, your income must not exceed 200 percent of the federal poverty level to receive 100 percent financial aid. If your income is more than that, you can still often qualify for a certain percentage of aid if you meet their debt-to-income ratios.

Note that the amount of paperwork you need to complete for financial aid can seem extensive, but it is worth the hassle to lower your medical debt. Most hospitals also require you to use all your available personal resources before they will help cover your medical bills.

Before requesting financial aid, gather important paperwork such as proof of income, a list of debts and assets, bank account balances, investment and retirement fund information. If you are unemployed or do not have any assets, provide proof of that status.


Discounts are another form of financial aid offered by hospitals. If you do not qualify for 100 percent financial aid, you may still be able to have a certain percentage waived from your bill. If they will not provide a discount on the overall bill, you still may be able to negotiate discounts on individual procedures or medications you received.

If you do not have health insurance, ask for an uninsured patient discount. These discounts can provide significant savings.

Another hospital discount option may be available if you have a large amount of money in savings. Offer to pay the bill in full, but present a total amount much lower than what they are requesting. Many hospitals are willing to negotiate deep discounts in exchange for a cash payment.

Doctors’ offices usually offer a discount to cash-paying customers. Even if you have health insurance, it may be worth asking about the doctor’s cash discount policies because they may result in a lower overall out-of-pocket expense.

For example, if your doctor charges $60 for an office visit and offers cash customers 30 percent off, you could end up paying less than you would if your health insurance co-payment is $50.

Payment Plans

Note that after a hospital stay, you may need to negotiate payment plans for many individual bills. You will receive invoices from the hospital, multiple doctors, the lab and the ambulance service, if you used one.

Carefully read each bill and ask for an itemized statement if individual services are not listed. You may see charges for services you did not receive or other kinds of overcharges, and negotiating these should be your first step in working out a payment plan.

Look at your overall household budget and realistically figure out how much you can afford to send to each bill every month. Then contact the billing departments and inform them of how much you can afford to pay and when you can pay.

After negotiating and agreeing on a monthly payment amount, be sure to stick to your agreement and make your payments on time.

Second Opinions

Nothing says that you must go with a doctor’s advice unquestioningly, especially if it involves an invasive or expensive procedure. It can be worth the cost of another co-payment or cash-paid doctor visit to get another opinion.

Even though both doctors may be well-educated and well-intentioned, each will have his or her own opinions about the best course of treatment for your condition. A different doctor may be able to offer treatment options that are less expensive or less invasive.

If your second-opinion doctor recommends the same treatment plan, ask for an itemized statement from each doctor. You may find a big cost difference between the two.

Hire an Advocate

If you have exhausted all your options to fight a medical billing problem or to negotiate payment on an overwhelming amount of medical bills, contact the Patient Advocate Foundation to receive free assistance.

This association can help you find a patient advocate that can help you address any problems and lower bills that you believe are being overcharged. Advocates review your bill and compare it to “usual and customary” charges.

Then, they contact the provider to negotiate for a lower price on your behalf. Although medical billing advocates usually charge a small fee for their services, it will not be anywhere near the amount they can help you save.

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