The Secret to Negotiating a Lower Medical Bill

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Easing the Burden

While insurers rake in billions of dollars in profits, more than 100 million Americans are saddled with health care debt. It’s a problem unique to this country, where medical bills are high, insurance coverage is lacking, and medical debt is the leading cause of bankruptcy. Although these issues are systemic, patients can advocate for themselves to lower (or even eliminate) their medical bills. Here are the best ways to negotiate medical bills and deal with debt, according to health care experts.

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Ohio Hospital by Sixflashphoto (CC BY-SA)

Go to an In-Network Provider

While the government technically mandates that nonprofit hospitals provide charity medical care, recent reports have found that they can be just as predatory as for-profit institutions. It’s more important that your provider is in-network, said Ruth Lande, the vice president of hospital relations at the nonprofit RIP Medical Debt. Patients usually pay less when they visit in-network providers because insurers have negotiated a contract with those hospitals and doctors. Lande said email is a great way to ask, as it saves time and maintains a written record.

Related: Prescription Drugs That Cost More Than a Car

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Elliot Hospital NH by Clovercreativegroup (CC BY-SA)

Apply for Financial Assistance in Advance

Another tip: apply for assistance from the hospital in advance. Even if you have a “decent income,” don’t be afraid to apply, Lande told Cheapism, because staff might factor in other “financial pressures,” such as sick family members. “Do provide details,” she added.

Related: Reduce Your Health Care Costs With These Expert Tips for Seniors

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Don’t Pay with a Credit Card (or Loans)

According to Kaiser Health News, around 1 in 6 adults are paying off medical or dental debt they put on a credit card. “Don't put it on any kind of card that will then be charging you interest, because that's going to make the problem worse,” Lande explained. Thanks to recent policy changes, patients will have a full year until medical debt shows up on credit reports — even more reason to avoid using credit cards. What’s more, in July the three major credit bureaus of TransUnion, Equifax, and Experian removed paid medical debt from credit reports. More changes are planned for the first half of 2023: Credit bureaus plan to stop reporting medical collections debt under $500.

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Contact the Doctor or Hospital

If you don’t apply for financial assistance in advance, request it after your procedure. Patients who don’t have time to call can write a letter or email and ask for a payment plan or other assistance, Lande said. Many hospital charity benefits are income based, but don’t be afraid to apply. Nonprofit hospitals must provide discounted or free care to low-income patients — and yet 45% of these hospitals send out bills to patients eligible for charity care, according to KHN. No matter your situation, it doesn’t hurt to ask.

Related: Countries Where Americans Can Save Big on Medical Care

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Luke Chan/istockphoto

Request an Itemized Bill With CPT Codes

Lande, who has worked in hospital billing departments, said she doubts there are as many billing mistakes as people think. That said, other experts urged patients to request an itemized bill that can be scrutinized for errors, such as duplicate charges. Patients can also ask for Current Procedural Terminology codes, which medical providers use to report medical services. “Google each CPT code to get a description of the billed medical service and what Medicare pays for the service,” said Virgie Bright Ellington, a physician and the author of a book about medical debt.

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Examine the Insurer’s Explanation of Benefits

Similar to a bill, an insurer’s Explanation of Benefits provides an overview of the medical services you received, including a cost breakdown. Ensure that the charges on your EOB are accurate, and compare the statement with your itemized bill to see if there are discrepancies. Make sure they’re not charging you for surprise emergency services, which the No Surprises Act banned in 2022. Patients who get surprise bills can file complaints on the Center for Medicare and Medicaid Services website.

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FG Trade/istockphoto

Apply for Medicaid

In some states, Medicaid covers medical bills retroactively. In other words, if you’re uninsured and receive a hefty medical bill, you can still get it covered by Medicaid as long as you apply and are approved within 90 days of your procedure. Check with your local Medicaid office to see if you qualify.

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Organize for Systemic Change

Lande, whose organization buys and forgives medical debt, stressed that expensive medical bills and debt are products of a flawed health care system. While policy changes won’t happen overnight, Lande pointed to Medicaid expansion as one solution. “The only people really now who are safe from medical debt are people with Medicaid because it doesn't tend to have any out-of-pocket [expenses],” she told Cheapism.