We all know that medical bills are never fun but, as most non-fun things, they’re a part of life. When you’re healthy it’s not something most people want to think about. But whether it’s a nagging cough that won’t go away, or an accident that requires going to the emergency room - sooner or later we all have medical issues which will require treatment. Treatment that will undoubtedly be expensive.
When that emergency strikes, getting better should be your priority, and you most likely won’t even think about how much it will cost until after the fact.
Medical bills can be unexpectedly high, and vary depending on a variety of factors. You might get a surprise amount due because insurance didn’t cover something and it might never occur to ask, “Can I negotiate hospital bills?”. The answer is, yes it’s actually possible to reduce the amount in your medical bills through the art of negotiation because medical fees aren’t always set in stone and bills can be argued in your favor. There are also ways to dispute the bill which can bring down the amount of what you owe, as well as some very valuable resources that can help make it more affordable. So before a collection agency starts coming after you and you start selling off prized possessions or considering bankruptcy or even just start tightening the belt, master these six effective strategies that can help lower your medical bills.
Regardless of whether you have health insurance, in order to get your bill lowered, it’s important to know what actually belongs on it. When you see a doctor, they keep track of all the medical items and services for which they can charge you. Once you leave, they send all the information to their medical billing department.
It’s the billing department’s job to put together an itemized medical bill that accounts for all the services provided. From routine consultations with your doctor to emergency room visits, everything has a price. It’s important to note however, that these prices are not set in stone. This is partly why it can take so long to receive any sort of billing information after a medical visit - it’s complicated. Every item in the bill must be first converted into a code which determines what it is and how much it costs.
Two to four weeks is standard before receiving a statement from your insurance company about the services you received during treatment, and this is separate from the actual medical bill you’ll need to ultimately pay. If you have health insurance, which everyone should, the information about your treatment will first be submitted to your insurance company as a claim. The insurance company will look at what kind of policy you have with them to determine how much your benefits will cover. For instance, was the emergency room or doctor bill in or out of network? Insurers will review all of this along with the medical codes and decide which services they will cover, and how much of the total bill they will pay.
Next you’ll receive an “explanation of benefits” (also referred to as the EOB) in the mail, sent by the insurance company. This is a breakdown of all the medical services you received, their itemized costs, and how much the insurance company is willing to cover. But it is very important to remember that the EOB is not the bill. It will however, be an important part of your negotiation strategy for paying the bill later.
It’s hard to know whether the bill is correct if you don’t know for what you’re paying. Imagine going to a restaurant for dinner and getting a bill for $500 with no breakdown of the menu items you ordered. You’d want to know why they’re charging you so much, right? With medical bills it’s no different. If you received a bill that looks too general, ask for an itemized breakdown as soon as possible. You’ll need to contact the billing department at the facility, or you can also ask to speak with the patient account manager. Once you receive a detailed breakdown of the bill, you can compare it to the EOB sent from the insurance company and make sure it makes sense. If you have questions about certain items, always ask for clarification from the medical office and/or insurance company.
It’s helpful to keep in mind that the numbers in your bill can be wrong. Medical billing is complicated, and mistakes can be made. This can work in your favor if you scrutinize all the paperwork sent by the medical facility and the insurance company. Ever double check the receipt at the grocery store to make sure the coupons were applied? With medical bills there’s even more on the line than a free roll of paper towels - mistakes could mean the difference of thousands of dollars you may not be responsible for.
Upon further investigation of the paperwork, it’s possible that you won’t have to pay for certain services or fees since it may have been a medical billing error. There could be duplicate items that shouldn’t be listed, or you may be getting overcharged for services you did not receive. Or it could be an error on the part of the insurance company - they sometimes make mistakes with how your benefits are applied. So if the numbers in your bill seem too high (or even if they don’t), it can’t hurt to ask. You have every right to know what you’re paying for. If you find an error (or have questions), contact your insurance company as soon as possible. They can work with the medical office to rectify any mistakes in your bill.
You can also contact the medical office directly, or have someone do it for you on your behalf, and request an audit of your bill to address any fees you want to dispute.
It’s important to remember that the numbers are not final. There is room to negotiate. After taking the time to learn how medical billing works and receiving an itemized bill, you can look into which items are prime for negotiation. It will be helpful to first visit websites like Healthcare Bluebook and FAIR Health to compare pricing in your area on the health services you received. If you’re being charged higher than what you see from other medical facilities in your town, this is a perfect opportunity to negotiate a better price.
It’s like retail shopping, many stores will honor coupons or pricing from their competitors since they want to retain your business. Consider your goal to be reaching an amount that you can afford that is less than the original, and still covers the cost of the medical treatment. How much you’ll actually end up owing in the end can be reduced greatly through the process of negotiation. When you begin negotiating your medical bill, it’s important to remain calm and humble - do not get upset or raise your voice. If you come across as angry and difficult it will cause the other person to see you as an adversary rather than a fellow human being who is having financial difficulties. Be nice to the people you talk to and they will be more motivated to help. They may be able to apply discounted pricing that you qualify for, or identify certain line items that can be removed from the bill altogether.
In negotiations it’s important to find any kind of leverage you can, even if it feels like you have very little to work with. You can also inquire about arranging a monthly payment plan that you can actually afford. After all, something is always better than nothing when it comes to getting paid. Just make sure you’re not being charged interest with your payments. If confrontation makes you uncomfortable, do your best to treat it as a game. Don’t take it so seriously, since you already know the worst case is paying the bill in full. Therefore, getting the bill lowered by any amount should be considered a win.
When you talk to the medical office or insurance company, it’s best to be honest about your financial situation. Ask them if they have income based pricing if you don’t have a lot of money coming into your bank account. The services have already been performed and if they know you are struggling to pay the total amount, they’re going to try to work with you. Whether they admit it or not, medical offices do have some wiggle room when it comes to billing. For example, did you know there are different prices that hospitals charge depending on which insurance you have? It’s common for hospitals and doctors to make deals with big insurance companies to get better prices for their members. This is called the “negotiated rate.” Even if you don’t have health insurance you can request to be charged at the same negotiated rate as those that do.
There are also discounts for the uninsured (or underinsured) that you may be entitled to. Many hospitals also offer what they call Charity Care programs, which are similar to how financial aid works in higher learning institutions. If you’re looking at a high medical bill, Charity Care and other discounts are certainly worth inquiring about before sending any payments. To help your case, be prepared to provide documentation such as bank statements, tax forms, and pay stubs from your employer.
If you are facing major health issues and don’t have a lot of income, you may be able to get relief through the government. Medicaid programs exists in order to help people who can’t afford healthcare, so be sure to see if you qualify. Depending on the state in which you reside, Medicaid may allow you to enroll in arrears if qualified. Even if they do not, there are still some other resources that can still help you. If you’re suffering from a chronic illness, there are many non-profit groups that exist to help pay for treatments.
One resource that can help with unpaid or looming medical bills is the Patient Advocate Foundation. For more than 20 years they’ve been offering case management services and financial aid for health related issues. It’s a fantastic organization, and they’ll be happy to work on your behalf to find sources of reimbursement for your medical care - at no additional cost to you.
Another great resource is BrokenHealthcare.org, which provides some very valuable information about medical bills and ways to argue them. Their website offers a clear and easy process on how to dispute your medical bill, outlining a proven strategy that has worked for countless people. They have excellent tools to help obtain more detailed information from whoever is charging you - which will give you surer footing to advocate for yourself when negotiating your medical bills.
Health issues are personal, and can be a sensitive topic to discuss. If you’re having trouble paying medical bills, take solace in the fact that you’re not alone. As you can imagine, unpaid medical bills are a huge problem in the US - causing people serious stress and even leading to bankruptcy. Looking at the total amount you owe it’s often unclear for what you’re even paying. As you go through your medical bill and find yourself wondering, “why am I paying for this?” or “why is this bill so high?” - take the time to ask your provider. Call the doctor’s office and let them know you have questions about your bill.
Also remember, it’s incredibly important to ask for an itemized bill if they have not provided it. As a patient you have a right to know exactly what you’re paying for - and why it costs so much. Once you have all the billing information from the medical office and insurance company, take some time to go through all the options you have for payment. Make sure to ask about discounts that can be applied.
Peruse the Patient Advocate Foundation website for charitable resources that can help pay the bill. Work with the templates that Broken Healthcare.org provides to ensure a solid strategy to dispute items in your bill. Even if you still end up owing money, going through each of the six steps outlined here could end up saving hundreds, even thousands of dollars.
A version of this article first appeared on our partner site: AgileHealthInsurance.com
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