How to Negotiate Your Medical Bills Down

Discounts and help are available if you know how to go about it

Doctor consulting patient in hospital
••• Thomas Northcut/Digital Vision/Getty Images

If you get slammed with a monster-size medical bill, and you don't have the funds readily available to pay it, don't panic. There are steps you can take to negotiate your bill down to a lower amount or make smaller, more manageable, payments.

Check the Bill for Errors

This can be tricky because medical bills have their own unique language, but you can determine whether your bill is accurate if you know where to focus your attention.

Virtually all procedures are coded to facilitate collections from insurance companies. You can do an online search to find the meaning of the medical codes that appear on your bills. You can compare the meanings with your procedures to find out whether you're being billed for the treatment you actually received.

Some errors are surprisingly commonplace:

  • Codes might be mismatched, which means they don't line up with your diagnosis. If the codes don't match, your insurer, if you have one, will most likely decline to pay any portion of this claim.
  • Upcoding involves a bill for treatment that might be similar to what you received, but it's not the treatment you underwent,and it usually costs more.
  • Other errors can include numerous billings for the same procedure, known as duplicate billing.
  • And unbundling is when services that should have been billed under one umbrella diagnosis or code are broken out, often adding up to additional costs.

Call your doctor, the hospital, or your insurance provider if you find discrepancies. Question the charges, and ask for a new, accurate bill.

Negotiate for Insurance Rates

If you're uninsured, then you may be charged a higher rate. Look up the fair market price for the care you received. This is the amount that providers regularly accept from insurance companies as payment in full, and it's the amount you should aim for in your negotiations. You can find this information in the ​Healthcare Bluebook.

Contact the billing department to negotiate a lower payment after you have this information. Politely ask to speak to a supervisor if the individual you're speaking with summarily turns down your request. Keep moving up the organizational chart until you reach someone who's willing to help you, or until you reach the highest authority.

Cash is King

Ask your doctor or the billing manager if they'd be willing to give you a discount for paying in cash if your initial request for a discount based on hardship is turned down. Point out that your cash payment will save the office credit card fees and staff time in processing paperwork. Instant cash flow is hard for any business to decline, especially if you offer to pay at the time of service.

Of course, you have to have the cash available to pull this off. Find out if a family member or friend can help you out if you don't.

Negotiate Payment Terms

Occasionally you will come across a service provider that just won't budge on price, but don't give up and whip out your credit card just yet.

Work to establish a payment plan that meets your needs instead. Be crystal clear about your ability to make payments. Tell the billing representative how much you can pay and when you can pay it. If they ask for larger payments—and they probably will—explain that you simply can't afford to do more. In all likelihood, they'll accept what they can get rather than not get paid at all.

Even if you pay small bits over an extended period of months because that's all you can afford, the provider is not going to turn you over to collections. It will accept your money each month and send you a new bill the next month...and on and on, unless and until you miss a payment.

Don't offer or agree to pay more than you can afford under any circumstances. Falling behind in your payments will destroy any future negotiating power you might have.

Get Outside Help

If all else fails, consider reaching out for help. Numerous health care and medical billing advocates are out there, such as the Patient Advocate Foundation. The downside is that many of them cost money, too. Still, they'll go to bat for you if you're not getting anywhere on your own, and some offer sliding-scale fees based on your income.

More Considerations

Keep these items in mind when you're facing what looks like a medical bill you can't handle:

  • Insurance companies negotiate with health care providers all the time. You can, too. No one will think you're stingy for doing so.
  • Call the billing department right away when you get a bill that you can't afford to pay. It's harder to negotiate a bill after it becomes delinquent.
  • Stay polite and maintain your composure. No one wants to help someone who's rude.
  • Doctor fees and hospital bills aren't the only bills you can negotiate. You can also negotiate your dental work and lab fees. 

When Possible, Act in Advance

Many physicians and facilities have programs in place to help those who are financially strapped, but they won't necessarily tell you about them unless you ask. The important thing is to let them know candidly and as early on as possible that you'll need help.

Ask for a discount ahead of the procedure or service if it's not an emergency. Speak candidly with your doctor or service provider about your circumstances. If you don't have insurance or your provider doesn't cover the procedure, then say so. Your doctor needs to know if you're living on a fixed or low income, or if other factors will make it difficult for you to pay.

Some hospitals might require that you apply for Medicaid first before offering you a discount on services.

Get it in writing if you're successful in negotiating a discount. You might need this confirmation later. In fact, you might want to make your pitch in writing as well, so that you have a record of it, or back up your conversation with a written communication summarizing what you spoke about, whom you spoke with, and any terms you reached.

Make sure you understand what's included in the price you've been quoted. Does it cover anesthesia, or is that extra? A discount on the surgery might not do you much good if anesthesia isn't covered, and that cost alone could empty your bank account.

Make Good on Your Promise

If you agreed to pay at the time of service, do it. If you agreed to send in regular monthly payments, get those payments in on time each and every month. Failing to do what you promised could cause the provider to rescind any discount extended to you, which could indeed land you in the collections department.

Key Considerations for Negotiating Medical Bills

Keep these items in mind when you're facing what looks like a medical bill you can't handle:

  • Insurance companies negotiate with health care providers all the time. You can, too. No one will think you're stingy for doing so.
  • Call the billing department right away when you get a bill that you can't afford to pay. It's harder to negotiate a bill after it becomes delinquent.
  • Stay polite and maintain your composure. No one wants to help someone who's rude.
  • Doctor fees and hospital bills aren't the only bills you can negotiate. You can also negotiate your dental work and lab fees.