7 Ways to Negotiate Medical Bills

By Mikey Rox on 26 June 2015 1 comment

When you've just had a medical procedure, you should be concentrating on recovery — not how you'll cover the bills. But what happens if you can't make a payment? While you can't make the bills disappear (unless you pay), you can probably reduce your financial burden if you know the right questions to ask. Get a leg up with these seven ways to negotiate your medical bills.

1. Learn to Spot Common Medical Billing Errors

I don't want to suggest that medical bills purposefully contain errors, but sometimes honest mistakes do occur, and you need to know how to spot them.

"Every procedure performed by a health care provider has a code that allows the provider to bill your insurance company," licensed health care attorney David J. Holt explains. "The issue with coding is that the average person has no idea what the codes mean."

To catch you up to speed, Holt deciphers the definitions behind some those codes for you.

Upcoding

A medical bill that is improperly charged as a different treatment, typically a more expensive one. This is most common when a name-brand medication is billed for a generic medication.

Unbundling

Where services that should be packaged together are split and billed separately. This is common when multiple medical tests are ordered, but all relate to one medical diagnosis.

Duplicate Billing

This is more common than you would expect. This is where you are billed multiple times for the same procedure, perhaps 25 times instead of 23.

Mismatched Coding

This is when the treatment code does not match the diagnosis. In this situation, the insurance company then denies the claim. The bill is sent back to the provider and will either be corrected or sent down to you, the patient.

Balance Billing

This is the leftover balance after the insurance company pays. All of the charges may be covered under your policy, so you may not actually owe this "leftover" amount. Uncommon, but still happens with automated billing processes.

In effect, you should question all charges and make sure the bill lines up with the actual treatment. It's important to be an educated patient.

Don't be afraid to "call your biller and health care provider to determine what a bill and code mean," Holt says. "It is your right as a patient and health care consumer to know what you are paying for."

2. Go Into a Procedure Knowledgeable of Fees

While knowing what the codes and charges on your bills actually mean is important, so is knowing all the fees you're incurring from your procedure. Because how will you know after the fact what's legit, if you didn't know beforehand?

There's nothing wrong with raising these question in the initial stages. Cheryl Reed, a representative for Angie's List, says the company has been advocating for years that patients need to be more empowered and bring their negotiating skills with them when they work with the medical community.

The first step is to get the quotes in writing. "If you're price shopping before you have a procedure done, get a signature, name, and title to go along with the price quoted," she says.

You also want to cover every doctor in the room.

"When getting prices, be sure you cover all fees associated with your procedure, rather than just the surgical costs — e.g. anesthesiologist, radiologist, laboratory costs, etc.," says Reed.

3. Ask If You Qualify for Discounts

There are very few instances when I'm buying something that I don't inquire about a discount. Many times it's under-the-radar savings that I would never know about unless I speak up. Such is the case with medical bills. There are discounts available in some situations — all you've got to do is ask.

"The doctor I go to is part of a hospital network that automatically gives you 10% off if you pay the bill over the phone," says Zina Kumok, whose frugal habits helped her pay off her student loans in full in three years. "You have to ask for the discount, but it's an easy way to save money."

Kumok also revealed another back-door tactic to lower the cost of medical bills — something called a charity care program, and it can save you big bucks if it's available to you.

"A lot of people probably qualify for some kind of charity care program," she says. "I applied for my doctor's program and found out that I'm eligible for a 30% discount after what my insurance covers. The key to saving money on medical bills is to ask. Usually providers won't tell you about any deals you can make. You have to be proactive and pursue any discounts you're eligible for."

4. Familiarize Yourself With Health Care Mumbo Jumbo

There's a lot of insider jargon associated with health care and insurance companies in general, and my opinion is that they're banking on you not knowing what much of it means, being too afraid to ask because you don't want to look uneducated, and then taking their word for it. You're doing yourself a major disservice by accepting your bills at face value. If you don't understand any part of it, question it; your wallet might thank you.

Holt knows that this problem is all-too-common, as he's dealt with plenty of patients who have fallen victim to it.

"How many Americans read through the entire health plan contract?," he asks. "Not many, and not knowing the terms may lead to thousands of dollars in medical bills because you were unaware of your coverage. Don't let this happen."

Here are few prominent terms with which you should absolutely familiarize yourself.

Deductible

This is the amount that you pay out-of-pocket for health care before your insurance starts to pay. For example, for a $2,000 deductible, you would need to pay $2,000 before your health insurance would start covering costs.

Co-pay

This is a certain dollar amount associated with a type of care. For example, you may need to pay $25 for every visit to a doctor.

Co-insurance

This is similar to the co-pay, but in this case, there is a percentage you will pay for a certain type of care. For example, you may need to pay 30% of the cost for an outpatient surgery. Therefore, your insurance would pay the remaining 70%.

In Network vs. Out of Network

In-network refers to providers (hospitals/clinics) that are covered by your insurance and out-of-network means limited or no coverage by your insurance. Why doesn't your health insurance cover all providers? It saves them on costs. Health plans contract with specific groups of providers for group discounts. Other providers are "out-of-network" and have different coverage rates, or are not covered at all. You should avoid out-of-network care if possible.

5. Visit the Hospital's Billing Department

Spotted an error on your medical bill? Does something seem fishy? Don't brush it off and resolve to pay it just to save time. Because if it happens once, it's likely to happen again — and you need to nip that in the bud right away. Visit the hospital's billing department in person to sort it out.

Another reason you may want to visit in person is if you're having a hard time paying. Maybe there are no errors on the bill, but you just can't afford the monthly payment. Instead of letting yourself go deeper into debt with late fees and other charges, have a one-on-one conversation about your financial situation with the source. You may be surprised by what you can work out.

Chicago-based RN and patient advocate Teri Dreher advises her clients to do the same.

"My tip would be to go to the hospital's medical billing department directly if one is having a hard time paying," she says. "Even if you pay a small amount every month, they will not give the payment to collections. It's the person who does not pay at all that has the case go to collections."

"If your economic situation improves after a few months, sometimes one can negotiate for a portion of the bill to be forgiven if the remainder is paid in full," Dreher says. "I would also review the entire bill very carefully for accuracy as hospitals and physician offices often send out incorrect bills and charges. Accuracy is sometimes sacrificed for speed of getting the bills out."

6. Be Polite, But Not a Pushover

You know the old saying: You catch more flies with honey than vinegar. That's an important rule to remember when negotiating your medical bills. Being rude will get you nowhere. Be polite but persistent, and you'll find the negotiating process much easier to manage.

Holt offers a few suggestions on preparing for the phone call with your biller.

"Don't lose your composure on the phone; remain calm and objective," he says. "The biller is taking notes on your conversation. Clearly communicate your financial situation. Say, 'I am willing to pay something, but unable to pay the entire amount. Given my financial situation, what are the discounted payment options available for me?' Offer to pay a discounted percentage of the bill up front (say $100 today for a $500 bill). Hold strong here. Request for the payment terms to be as long as possible. Generally, you will have a maximum of two years from the original billing date to pay off your bill. Request an 'interest-free payment plan' for a discounted amount of the total bill. Health care providers are getting clever about collecting debt and offering all sorts of 'low interest medical-credit' plans. In reality, this is just a credit card with the health care provider. Since when did my health care provider also become my banker? I do not feel like that is right."

In other words, avoid the medical credit plan option at all costs; it's likely to cost you much more in the long run. Try to find a way to pay the bill down without accruing any more fees. If you can't afford the cost of the bill now, you definitely can't afford to start tacking on high interest fees to lower a monthly payment.

7. Call an Expert for Help

If you feel completely ill-prepared to negotiate your own medical bills, there are experts out there who can help you. These experts aren't free, of course, so you really need to weigh your options before calling in the big guns. Will these additional fees that the experts charge break even after the negotiations? It's hard to tell, so it's wise to proceed with caution in this area.

Nonetheless, Reed points out that these reviewed and trusted experts can be found on Angie's List.

"Medical billing is so complex that it's spawned a new industry of professional bill reviewers, sometimes called patient advocates," she says. "These specialists, who are rated on Angie's List, are trained to look for incorrect billing codes and duplicate charges. Experts say advocates can recover 17% to 49%, and charge an average contingency fee of about 30%. Some charge flat fees, as well."

Do you have other suggestions on how to negotiate medical bills? Let me know in the comments below.

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Guest's picture

Great article! Here are a few other tips I have from working down in the trenches as a healthcare attorney:

Price-shop your health insurance and your treatments BEFORE you go in for healthcare. There is a free healthcare blue book just like the automotive blue book for buying cars. Make use of this to determine what prices are reasonable for your location and type of care. Healthcare is a commodity after all. You already shop for electronics, houses, cars, and food - make sure you are doing the same for your healthcare.