How to Negotiate a Hospital Bill After Insurance Pays
Insurance paid their portion but you still owe thousands. Here is how to negotiate the remaining balance down significantly.
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Step 1: Get the Itemized Bill and Compare to EOB
Call the billing department and request a fully itemized bill with CPT codes for every charge. Compare each line item against your insurance Explanation of Benefits. Common discrepancies include charges that insurance already paid but the hospital is billing you again, out-of-network rates applied for in-network services, duplicate charges for the same procedure, and charges for services you did not receive. Up to 80 percent of hospital bills contain errors according to medical billing auditors.
Step 2: Apply for Financial Assistance
Most hospitals are required to have financial assistance programs (also called charity care). Ask the billing department for the financial assistance application. Eligibility is typically based on income relative to the federal poverty level. Many hospitals reduce or eliminate bills for patients earning up to 300 to 400 percent of the federal poverty level. Even if you have insurance, you may qualify if your remaining balance is a significant portion of your income. Non-profit hospitals are legally required to have these programs.
Step 3: Negotiate the Balance
Call the billing department and explain that you cannot afford the balance. Ask if they will accept a reduced lump sum payment. Many hospitals accept 40 to 60 percent of the balance if paid immediately. If they will not reduce the total, ask for a zero-interest payment plan — most hospitals offer 12 to 24 month plans with no interest. Never agree to a payment plan with interest or through a third-party financing company. If the billing representative cannot help, ask to speak with a billing supervisor or patient advocate.
Step 4: If All Else Fails, Get Help
If the hospital will not negotiate, hire a medical billing advocate. These professionals audit bills, identify errors, and negotiate on your behalf. They typically charge 25 to 35 percent of the amount they save you, so there is no upfront cost. Patient advocacy organizations like the Patient Advocate Foundation also offer free help. As a last resort, you can dispute the charges with your state insurance commissioner or attorney general office.
