How to Negotiate Medical Bills and Lower Payments

So you’ve just had a medical procedure. Big or small, you’ve had invasive work done, and you really should be focused on your own recovery, right now, not how you will cover the bills. But, instead of spending all day recuperating, you find yourself up all night worrying about medical bills.

First off, don’t beat yourself up over it. Whether it’s about health coverage or home insurance, finances are a top concern among most Americans.

“What if I can’t make a payment?” “Should I even get this done if I can’t afford it?” “Who could possibly help me navigate this whole mess?” And, while we’d all like to, it’s not like we can just make the bills “go away”.

But all is not lost. Did you know you can often lower your financial burden just by knowing what options are available to you? Don’t believe us? Let’s take a closer look at how to negotiate medical bills and lower your payments.

Attempt Negotiations Before Treatment

It might be easy to see most medical treatment costs as set in stone. They simply cost what they cost, and there’s nothing much say about the price. In the case of an emergency room visit, you’re pretty much stuck with what you get.

But there are times when you can negotiate medical bills. About to undergo a planned surgery or standard procedure? You may be able to negotiate the overall cost of your operation, well in advance of actually receiving treatment.

Try the following:

  1. Contact your hospital’s billing department to get an overall cost estimate for the procedure.
  2. Take this data to your insurance company for an estimate of what they’ll cover.
  3. Talk to the hospital’s billing department about how much you can afford.
  4. They may recommend a payment plan or financial assistance program.

Where many people slip up is in being too proud to ask the awkward questions. “Do I need this procedure?” “How much will all of this cost me?” Hospital procedures are a service, and services come with retail properties. Ask what the minimum price is or what you can opt not to have and still get the overall effect. 

You’re a customer. Maybe you bring in a six-figure salary. Maybe, like many others, you work from home and your income is less predictable. Whatever the case, it’s always best to reach out to the people responsible for your billing. Make sure to call your health care provider, never email them. Negotiating a better price on anything works better when you and the other party can hear each other’s tone of voice. Make sure to take notes about who you spoke to and when, get on the phone, and start getting some answers.

Build A Relationship With The Billing Office

For the most part, doctors’ offices aren’t as full of red tape and bureaucracy as you might think. They’re specialized finance departments, handling dozens of billing issues a day. Moreover, they’re customer service stations, tasked with interacting with customers and insurance agencies. 

If you’re expecting difficulties with payments, make an appointment to see the billing department. Ask to review your bill. Outline your insurance benefits and talk openly about your credit card capacity. With transparent, open conversations, there may be more opportunities than you might think.

Shop Around

It’s part of the insurance process to service customers with accurate cost estimates, where available. Many of the larger companies will even offer cost comparison tools, to help clients find the best deals on their services.

Then take that information wherever you need to get the service you need. Do your research and don’t jump at something because it seems like a good idea. Try a third-party website, like GoodRx or Healthcare Bluebook, for instance. These are unique tools, geared toward comparison work, and they offer huge databases of services for a better overall picture.

Don’t fool yourself: when it comes to your medical care, the most important factor is and always will be cost and level of care. It’s important, to be honest about your personal finance.

Understand Your Insurance Coverage

To review your hospital bills, you need a comprehensive understanding of what is and isn’t included in your policy. If you aren’t up to speed, how are you ever going to know how to negotiate your bill?

Start by getting in touch with your provider and asking for a full breakdown of your specific benefits and responsibilities.

Insurance Definitions For Your Benefit

To get the best of your request, make sure you come into a conversation with your provider’s healthcare department prepared. Keep some of the following to terms in mind and find out how they apply to you, specifically:

Coinsurances: This is the percentage of the overall health care costs each party is responsible for, once the deductible has been met. By way of an example, if your insurer were to cover 80% after your deductible, you’d be left paying 20% in coinsurance. With that information in-hand, you’ll have a good start on preparing to pay your bill.

Co-pay: This is the fixed amount you’ll pay for your health care service, provided it’s covered by your policy, once you’ve met your deductible. This number will change from provider to provider. This means specific costs from primary care physicians (PCPs), specialists, and dentists. This can help inform your decision before going to any specific provider.

Deductibles: This represents what you’ll contribute, overall, to your total medical costs in a given year before your provider starts paying. This is a bone of contention for many people, with higher numbers meaning you’ll be less likely to receive a payout before the financial year resets.

In-Network Service Providers: Healthcare providers contracted by health care providers can provide services at discount rates. This is why it’s important to know you’re dealing with someone in your network before going in for an appointment.

Out-Of-Network Providers: Providers operating outside of your insurance program don’t need to follow their regulations. As a rule, you’ll pay more to go out-of-network than to stay in.

Out-Of-Pocket Limits: This is the maximum amount you’ll be on the line for with regards to covered services in a health plan year. Hit this number, and your insurer starts paying 100% of your covered costs.  

Ask For An Itemized Bill and Check It For Errors

Once you’ve received treatment, waiting for the bill can seem like an endless ordeal. Within a certain amount of time, you’ll get an Explanation of Benefits (EOB) from your insurer and a statement from your health care service. It’s important to note that the EOB itself is not an invoice, and this number could be updated at any time during processing.

Don’t pay your EOB without first getting a bill from your supplier and checking it for billing errors and inconsistencies. As a further measure, have your healthcare provider go through where they will be sending your lab results and other tests. Labs, anesthesiologists, and other services have to be within your network in order to take advantage of in-network rates.

Common Medical Cost Errors

Medical bills can feature some sort of cost error or misrepresentation. And, when these numbers can easily reach the tens of thousands in many cases, it’s always worth giving it a second look. Consider some of the following: 

Preventive care: During a visit to the doctor, it’s easy for a lot of things to come up. You may end up asking for an opinion or recommendation and, receive a bill for a physician’s visit rather than preventative care.

On the flip side, it has been known for patients to accidentally receive charges for visits they were supposed to have for free. It’s always better to follow up and to check again.

Inaccurate Reimbursements: From time to time, insurance providers will deny your service claim for services they should, by all rights, pay for. It pays to be observant. Make sure to check your bills.

Double Billing: While it shouldn’t happen, sometimes you’ll make a payment, and billing will send out a bill without having checked your payment. This can happen, so make sure to follow up ahead of time.

Mismatched Codes: We’re all human, and mistakes happen. A health care professional could enter the wrong code, leading to reduced coverage and higher costs.

Similarly, you can make mistakes as well. Hand over any of the following incorrect information to your provider, and your claim could be denied:

  • gender, name, age, and social security
  • address and contact information
  • policy number

Payment Support Programs

It might be a little embarrassing, but one of the easiest ways to keep your costs down during a medical appointment is to simply ask for assistance. Ask the billing department of the hospital or laboratory you are working with about their financial aid and charity programs. If you are transparent about your needs, there could be many options available to help cut the costs of your appointment.

Most hospitals feature standard plans, put in place to help patients who can’t pay bills. Some may even offer uninsured discounts for patients without access to a full health insurance package. It’s up to you to bridge the gap in these situations to find out about them.

Prepayment For Discounts

As with many other options, prepaying your medical bill for a discount won’t always be an option, but many doctors’ offices offer it. If you have the funds to pay most of your health care upfront, ask about a discount with the billing department. Ideally, you’ll offer to pay most of your bill immediately, and then see if they will offer you a discount.

When you reach the billing department, specifically ask to speak to someone who has the actual power to make the change on your behalf. Always remember to take detailed notes of who you spoke to and what they confirmed or denied. Ask them to repeat themselves and make everything as clear as you can.

Also, make sure to keep in mind that paying in cash can help to bring down your overall bill, as well. Doctors’ offices sometimes offer discounts for paying in cash since that reduces their transaction fees.

Payment Plans

A health care provider may offer interest-free reimbursement plans for people who might not be able to pay off their expenses. Instead of demanding payment in one big payment, this is a more practical solution that leaves everyone settled up.

It must be said, you should never accept a payment plan if you’re worried you might not be able to pay it off, realistically. This is a way to mitigate this expense, not remove it entirely.

Online Survey Service Costs

Third-party healthcare websites have emerged as viable options for searching for cost estimates. Consumers can find insights, with approximate medical costs available online for a range of locations. This is a consumer service, including individual hospitals and insurance companies.

Receive a diagnosis for your procedure, and you can throw further online research on top of that to educate yourself. There’s nothing more powerful in consumer culture than a customer with information.

Local Advocates

This is something many people don’t expect, but local advocates are a very real option for securing better deals on your medical bills. Specialist health care professionals can provide local health care information.

With the help of a patient advocate foundation, you can get the care you need from insurance companies and medical providers at a better price. There’s also plenty of information available to help you resolve your billing with fewer complications. Look into local support from a patient advocate to help you take the sting out of your payments.

Mitigate Medical Debt and Medical Bills

Year after year, Americans deal with an endless series of challenging medical experiences. From New York to LA, the one common thread is that patients need better deals so they feel ready to respond to their health issues.

Whether you’re making a phone call to your doctor’s billing department or consulting with a patient advocate, you have options. Hopefully, today’s article has given you the insights you need to get a better deal on your healthcare.

Looking for more insights into your finances? Make sure to check out some of our other blog content, today!

Latest Articles

Pin It on Pinterest