Understanding and Negotiating Medical Bills
Author: Jenni Nolan, BCPA
Reading Your Medical Bill: Itemized Charges, Codes, and Errors
Medical bills differ, but should include – at minimum – your demographics, the service(s)/procedure(s) for which you’re being billed, any insurance/payment adjustments, your remaining balance, and instructions for making payment. If you’re uncertain as to what you’re being billed for based on the initial bill you receive, contact the provider’s billing office to request an itemized statement, which will include much more detailed information.
After reviewing your medical bill, you’ll want to compare it to its corresponding explanation of benefits (EOB) from insurance. Make sure the charges, dates of service, payments/adjustments, etc. match what is listed on your bill from the provider. Check to ensure the charges were processed according to your plan benefits. If something doesn't look right, contact your insurance company to get an explanation of how the charges were processed.
If you do identify an error on your medical bill (such as a charge for a service/item you didn’t receive, incorrect coding, etc.), reach out to the provider’s billing department to make them aware of the issue; ask them to correct the mistake and resubmit to insurance as a corrected claim.
Remember that resolving medical billing and health insurance claims issues usually takes more than one phone call. Don’t give in and just pay your bill – make sure things are fully resolved before paying!
Financial Assistance and Strategies for Negotiating Medical Bills with Providers and Hospitals
If you’ve already reviewed your medical bill(s) and insurance EOB(s) for errors and find that the amount you owe is more than what you are able/willing to pay, it’s time to consider financial assistance and/or fee negotiation.
Many providers/hospitals offer self-pay discounts and/or income-based financial assistance. In fact, non-profit hospitals in the U.S. are required to offer financial assistance based on federal poverty guidelines. You can usually locate a hospital’s financial assistance policy by an online search for “xxx hospital financial assistance.” There should also be information regarding hospital financial assistance instructions on the back of your bill. Even if you are above the federal poverty level, you may qualify for at least partial financial assistance.
In case you don’t qualify for financial assistance, you can ask for a self-pay discount, or you can try to negotiate the balance down. You’ll need to come up with a reasonable offer based on what you think is a fair price based on comparison prices, other research, and your ability to pay. Be sure to present your negotiated offer in writing and include reasoning for why you’re offering that particular amount (this often involves pricing research to be able to compare pricing with other facilities, other negotiated amounts, etc). It’s best to include the payment you’re offering along with your letter. Make sure to include a statement in the letter that says by cashing the check/accepting your credit card payment, the provider has agreed to the offer.
Payment Plan Options and Medical Debt Management
Fee negotiations may not be an option for everyone, as most providers will only accept negotiated fees when the agreed-upon amount is paid in one lump sum. If you can’t afford a lump-sum payment, or if negotiations are unsuccessful, ask your provider’s billing department if they offer a monthly payment plan. Most provider billing offices will allow monthly payments spread over a maximum of 36 months. Unfortunately, many medical bills are so large that the monthly payment for a 36-month payment agreement is still unaffordable. Try not to be pressured into a payment plan that you won’t be able to meet; as soon as you default on a monthly payment, your account might be kicked back into the collections cycle.
When to Seek Help: Medical Billing Advocates and Patient Advocacy Organizations
Navigating the US healthcare billing process isn’t easy, and most problems don’t get resolved in one phone call. If you’re overwhelmed by – or simply don’t have the time to deal with – a medical billing/health insurance issue, consider seeking assistance from an advocate or a patient advocacy organization.
You can search for an independent medical billing advocate via Google, or via online directories hosted by organizations like Greater National Advocates or Umbra Health Advocacy. Keep in mind that independent advocates charge for their services, and rates vary depending on geographic location, years of experience, and other factors.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC-BY-SA-4.0), available at https://creativecommons.org/licenses/by-sa/4.0/. SPDX-License-Identifier: CC-BY-SA-4.0
Signed-off-by: Jenni Nolan