How to Negotiate Medical Bills: A Step-By-Step Guide
June 6, 2023
Can you negotiate medical bills?
Medical bills can be daunting, especially when they arrive unexpectedly or when they are higher than anticipated. However, many people are not aware that medical bills can often be negotiated. In fact, negotiating medical bills can lower your annual healthcare costs by thousands of dollars.
If you want to learn how to get a hospital bill reduced, or negotiate a better deal for out-of-network medical services, you’ve come to the right place. This article will provide a step-by-step walkthrough for how to negotiate medical bills effectively. We hope it saves you from the unnecessary financial burdens associated with medical bills. And we hope it saves you time too!
1. Understand your medical bill.
The first step in negotiating your medical bill is understanding what it includes. Medical bills can be complicated, with various line items and codes that might not make immediate sense to the average person. Here are a few tips to help you decipher your bill.
Request an itemized bill.
Like a receipt, an itemized bill breaks down all the charges, including the cost of each procedure, medication, and service. This allows you to see exactly what you are being billed for and identify any errors or discrepancies.
An itemized bill given specifically for out-of-network medical services is called a superbill. For an in-depth explanation of superbills, read our post What is a SuperBill?
As you might have guessed from our name, we have some experience with superbills. We can get your superbills reimbursed for you for free! To learn more about SuperBill’s out-of-network claims filing services, visit SuperBill for insurance.
Double-check your medical codes.
Medical bills contain codes for identifying medical goods and services. The two most common types of medical codes are the Current Procedural Terminology (CPT) codes, which represent specific procedures, and the International Classification of Disease (ICD-10) Codes, which denote specific ailments. You can use resources like the American Medical Association (AMA)'s website to look up these codes and understand what they represent.
Note: it’s not necessary to know these codes by heart. But cross-referencing the codes in your bill with the AMA’s list will ensure you were billed correctly. If you spot a code that looks out of place, you may already be on your way to lowering the cost of your medical bills.
To determine if your bill is reasonable, compare the prices of the procedures and services with the average costs in your area. You can use resources like Healthcare Bluebook or Fair Health Consumer to find this information.
Alternatively, if the service you received was out-of-network, you can use SuperBill’s free out-of-network benefits calculator to see how much your insurer should cover. If you don’t feel you are getting the coverage you deserve, you might be able to negotiate lower medical bills from your OON provider.
Remember that unlike in-network providers who have a contract with your insurer, out-of-network (OON) providers set their own rate. Meaning the cost of your OON medical bills is completely negotiable. However, with non-emergency services, it is almost always easier to negotiate medical bills before you receive the service in question, so we recommend talking to your provider about their rate in your first consultation.
2. Verify your insurance coverage.
Before you actually start negotiating your medical bill, it's essential to understand your insurance coverage. Log in to your insurer’s website and check your Plan Details to see what your insurance covers and what you are responsible for paying. You can also check your Explanation of Benefits (EOB) to see what your insurer has covered in the past.
If you notice any discrepancies or have questions about your coverage, contact your insurer for clarification. Unfortunately, insurance companies can be difficult over the phone. It’s in their financial interest. But waiting on hold is worth it if it means you can significantly reduce medical bill costs.
If you want to skip the wait, SuperBill can do this for you. We verify your benefits, wait on hold with your insurer, and negotiate the best price possible for your medical bills. Then, we file and track your claims for you!
3. Identify billing errors.
Billing errors are more common than you might think, and identifying these errors can significantly reduce your medical bill. Here are some common billing errors to look out for:
- Duplicate charges: Make sure you are not being billed twice for the same procedure, medication, or service.
- Incorrect patient information: Double-check your personal information, including your name, address, and insurance details, to ensure there are no mistakes.
- Incorrect codes: Check the CPT codes on your bill to ensure that the correct procedures and services are listed.
- Unbundling of charges: Some procedures are billed as a package, but sometimes they are billed separately, leading to higher costs. Verify that you are not being overcharged due to unbundling.
If you find any errors, document them and contact your provider’s billing department to have them corrected. If you are trying to negotiate hospital bills after insurance has already gotten involved, it’s not too late. Call your insurer or write a letter of appeal to get the charge reduced or removed.
4. Research negotiation strategies.
Before you approach the billing department or your healthcare provider, it's essential to familiarize yourself with different negotiation strategies. Here are some tactics to consider.
Offer to pay upfront.
If you can afford to pay a portion of the bill upfront, you can sometimes reduce medical bills by earning a discount. Many healthcare providers are more likely to offer a reduced rate if they know they will receive payment promptly.
Try a payment plan.
If you cannot afford to pay the entire bill at once, ask about setting up a payment plan. Many providers are willing to work out a plan that fits your budget. As with upfront payments, the security of a payment plan may convince providers to offer a discounted rate.
Negotiate based on comparable rates.
As complicated and frustrating as medical bills can be, you do still have some power as a consumer. Here’s how knowing comparable prices for your medical services pays off. If you find that your bill is significantly higher than the average rates in your area, use this information to negotiate a lower price. Letting providers know you’ve done your homework can save you a lot on your medical bills.
5. Prepare for the negotiation.
Having the proper resources with you makes your negotiation considerably more effective. Before contacting the billing department, make sure you are prepared with all the necessary information and documentation. This includes:
- A copy of your itemized bill
- Your insurance EOB
- Any documentation of billing errors
- Research on average costs for the procedures and services in your area
6. Stay calm and persist.
From here, all that’s left for you to do is explain your case. Remember to be polite and courteous in your negotiations. Raising your voice or talking over the other party will almost never help your chances in a medical bill negotiation.
How to negotiate a hospital bill.
There’s one more thing we want to cover. What if it’s not a medical bill for routine services but an unexpected hospital bill. Can you negotiate hospital bills, and if so, how?
Yes, you can definitely negotiate hospital bills.
In fact, the guide on how to lower hospital bills is essentially the same as the one you just read. The main difference is that most of the time, you will negotiate hospital bills after insurance payers have gotten involved. Meaning instead of negotiating with your provider before the procedure, you will negotiate with the hospital and/or your insurer after it’s done. This is because of the nature of hospital visits, which are generally more spontaneous than other out-of-network services.
Follow the same steps we’ve outlined above to negotiate hospital bills. Often the high costs of hospital bills present a significant financial burden. However, many hospitals offer financial assistance for low-income or uninsured patients, so please know that you can apply for financial assistance at any time.
To apply for financial assistance with a hospital bill, contact the hospital and inform them about your financial situation. Ask if they have any programs for financial assistance, and once again, stay patient and polite. Most hospitals will do their best to accommodate your needs.
A new kind of medical bill negotiation.
We hope this article has helped you learn how to negotiate medical bills like an insurance pro. But we also want to offer a quicker, smoother alternative. With this post SuperBill would like to introduce you to our latest and most exciting service: medical bill negotiation.
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