How to Negotiate a Hospital Bill
When you go to the hospital to get the medical care you need, the last thing you’re considering is the hospital bill. Hospital bills can add even more stress to your recovery when they do come. The high costs of receiving care can strain your financial well-being. In fact, even with insurance coverage, many Americans face hospital bills that they cannot pay.
However, knowing how to negotiate a hospital bill will help you drastically lower your medical expenses. In this article, we’ll discuss how to negotiate a hospital bill, your rights as a patient, and other financial assistance options that can help you pay for your care. The first step to negotiating a hospital bill is to request and review your bills.
Request and review your medical bills
The first step to figuring out how much you owe is to request your medical bills. If you do not have an itemized bill, ask the hospital system where you received care for this bill. An itemized bill can help you see every charge you’ve incurred. It’s essential to understand how to read a medical bill so that you can understand the charges. An explanation of benefits (EOB) can also be helpful to better understand the care you received. These documents should tell you what care you’ve received, the total healthcare costs, how much of the care the insurance company paid for, and your out-of-pocket costs. Remember, these out-of-pocket costs can be higher for those who have a higher deductible plan or for those who are uninsured.
Once you’ve received your bill and are reviewing it, look for errors. According to Becker’s Hospital Review, up to 80% of medical bills contain some kind of error. Here are the most common types of errors;
- Duplicate charges: These are excessive charges as a result of being charged twice for the same procedure
- Incorrect billing: These are listed charges for services you didn’t receive
- Upcoding: This happens when expensive treatments or procedures are listed as a result of an inflated diagnosis
- Unbundled charges: This occurs when procedures that happened at once and should be charged under a single code are listed as separate medical services
- Incorrect billing codes: This is when a wrong billing code is listed for a procedure
Contact the healthcare provider directly if you’ve reviewed your bills and found an error. Explain the mistake to them and kindly ask them to revise the bill based on this information. If a claim has already been sent to your insurance company, contact them directly and explain the errors. They may be able to work with the healthcare provider on a resolution.
If no resolution is reached, you can also file an appeal with your insurance company. The appeals process can vary by company, so contact yours directly to understand its policy. If there are no billing errors on your bill, the next step is to begin the negotiation process.
Negotiating your medical bill
If you’ve reviewed your bill and cannot pay the total amount, it’s time to start negotiating with the medical provider. When you talk to the hospital provider’s billing department, explain your financial situation and tell them why you cannot pay the bill. Be kind and patient. Ask if they can lower the charges for this bill. To find a starting point for the cost of services, utilize a tool like Healthcare Bluebook or FAIR Health.
In your negotiations, you may also succeed by asking if they can lower your bill if you make an upfront payment. This option may only work for some, as it requires the money to pay a lump sum.
Another option is to work with the hospital system to agree on a payment plan. By working with the hospital directly, they may not charge interest on these payments over time. Contrast this approach with putting the entire bill on a credit card. With a credit card, you can pay up to 20-30% of the bill in interest charges from the credit card company. Therefore, it’s best to see how you can work out a payment plan with the hospital directly. Depending on your financial situation, you may qualify to receive financial assistance with your bills.
Exploring financial assistance programs
Financial assistance programs can provide a helping hand when it comes to paying a medical bill. If the services you received are considered “medically necessary,” you may be able to receive financial assistance. In fact, federal and state laws require most hospitals and healthcare systems to have financial assistance programs for these types of services. The Affordable Care Act (ACA) also helped establish that a nonprofit hospital must have written policies detailing financial assistance eligibility and what its program entails.
Hospitals have different names for these programs, such as Patient Financial Assistance, Bridge Assistance, or Charity Care. Those on Medicare, Medicaid, or other insurance must use those benefits before any financial assistance programs.
Eligibility requirements and the application process can vary per institution, so it’s essential to contact the hospital or hospital system directly to learn more about their assistance programs. Now, let’s look at the protections you have as a patient.
Understanding legal rights and protections
As a patient, you have rights in the medical billing process. In 2022, the government expanded patient rights through a bill called the No Surprises Act. For those with health insurance coverage through an employer, an individual health plan purchased directly from an insurance company, or the Health Insurance Marketplace, the No Surprises Act protects you from unexpected bills for most in-network and out-of-network medical procedures.
If you don’t have health insurance, your rights include access to a good faith estimate of the expected expenses for a visit or procedure. With this information, you can dispute the medical bill if it’s over $400 more than the good faith estimate you received before the procedure. However, you must file a dispute claim within 120 days of the date on your bill.
In addition to these legal protections, you also have the right to appeal if your health insurer refuses to pay a claim or ends coverage. There are two types of appeals: internal and external.
- Internal: You are asking the insurance provider to conduct an internal review of its decision during this appeal. You’ll need to follow the insurer’s instructions for the appeal and submit any additional information (such as a doctor’s letter).
- External: You file an appeal to a third-party arbiter. This arbiter decides in your favor, or they decide in your insurer’s favor. By law, the insurer must accept this decision.
Insurers each have their internal appeal processes. Contact your insurer to learn more about appealing a claims decision. Should the claims decision go against you, there are other ways to cover the costs of your care.
Crowdfunding for hospital bills
If you still have to pay for medical bills that insurance won’t cover, crowdfunding can help you bridge the financial gap. Getting started with GoFundMe is easy and straightforward, so you can get the support you need in just a few minutes. Whether you’re starting a fundraiser for yourself, a friend, or a family member, you can reach out to more people and share your story.
Long-term financial strategies to reduce debt
You can minimize future medical costs and reduce your financial strain in a few ways. First, take the time to pre-authorize procedures and verify your insurance provider will cover the expenses. This may seem tedious, but it can save you from unexpected costs after the procedure.
You can also look to savings plans specifically designed for healthcare. Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) provide vehicles for you to save money over time and then use that money to pay for qualified healthcare expenses. Health Reimbursement Arrangements aren’t traditional healthcare plans but allow an employer to pay an amount into a specific account for an employee. The employee can then use these funds to get reimbursed for medical expenses.
Finally, if you incur medical debt, try to pay it off quickly. If you don’t pay, you could face late fees, interest charges, debt collection agencies, lower credit scores, and even lawsuits. Therefore, do everything you can to start paying off this debt.
As mentioned above, you can set up a payment plan with the hospital or health provider to pay it off over time. Remember that these payment plans will often have more favorable terms than putting the amount on a credit card. Therefore, by working with the hospital directly, you could save a lot of money in interest charges.
Healthcare billing can be complex, but there are ways to negotiate your hospital bill. Crowdfunding for medical bills can be a great option if you need extra support paying your medical costs. When you’re ready, GoFundMe is ready to help. Get set up in just a few minutes and reach a broader audience today. With GoFundMe, you’re even closer to the financial help you need to pay your hospital bill.