Originally published on The Paper Gown: https://thepapergown.zocdoc.com/how-to-negotiate-and-lower-your-medical-bills/

Nothing adds insult to injury like getting a huge medical bill. Unfortunately, the high, and often financially debilitating, cost of healthcare these days is a fact of life. However, negotiating is easier than many patients know.

Sixty percent of Americans have been in debt due to medical bills at some time, per a 2021 survey by Lending Tree, to the point where it has interfered with buying a home, paying off other debt, or saving for retirement.Unpredictable and unavoidable procedures, such as emergency room visits and dental care, top the list as drivers of medical debt.

There are legitimate ways to avoid paying the entire amount you were billed. It may seem intimidating to try to negotiate a medical bill but making the effort will most likely pay off. The Lending Tree survey found that 93 percent of those who tried to negotiate their bills successfully reduced costs.

“There are some easy ways to lower your medical bills, it just takes a bit of time and a couple of phone calls to get things rolling,” says Tana Williams, a personal finance blogger who has never met a medical bill she couldn’t negotiate.

Here’s what you can do.

Try to negotiate beforehand

You can’t get ahead of unplanned medical care, like a trip to the emergency room. (Although now, healthcare providers are prohibited by law to charge you exorbitant surprise emergency-related costs.)

You might, however, be able to negotiate the cost of a planned surgery or procedure, like a torn ACL repair, for example. “It’s just highly dependent on the provider’s policy,” says Haden Marrs, Operations Director at Point Health.

Start by contacting the hospital’s billing department to get an estimate of how much your procedure will cost. (Typically, they will give you the estimated full price without any insurance.) Then, if you have insurance, share this information with your insurance provider to get an estimate of what your plan will cover. After, you can go back to the hospital’s billing department and see if they can work with you on lowering costs, either by offering a discount if you pay upfront with cash or setting up a payment plan.

“Labs and diagnostic services can be harder to negotiate since [they are] pretty straightforward, but some providers do allow for it,” Marrs added.

If you know you’re going to be paying out of pocket for a planned procedure that’s out-of-network, you can shop around with providers and ask for their cash-pay price. If the cash-pay price is still prohibitive, ask if they’d be willing to consider an upfront settlement for a reduction in the price. “With upfront negotiations, providers typically want some type of down payment prior to services being rendered,” says Marrs. “It’s also important to get anything they agree to in writing.”

Review charges with a fine-tooth comb

Reviewing an itemized bill can help you catch charges for items or services that you didn’t receive. It’s not uncommon to find you’ve been charged for duplicate doses of medication or tests that you didn’t receive, for example. By some estimates, up to 80 percent of medical bills contain errors.

“These mistakes happen because everything is tracked in your medical record, and then sent to a medical biller, ” says Williams. “The people who treated you are not the ones billing you, so it’s easy for items to end up on the wrong account or not be removed when the item or service is refused.”

“It’s just human error and happens to the best of us,” Williams adds. “Often if you call and ask about these items, they will adjust or remove them.”

You should also expect an explanation of benefits (EOB) from your insurance company in the mail. This is not the same as a bill (more like a receipt) but it will show you how much you were charged for your care. Compare them, and you may find discrepancies between the EOB and the actual bill. (Check out our guide to reading your medical bill here, and a guide to EOBs here.)

Ask for a cash discount or payment plans

If you’re in a position to cover a bill using cash, you may be able to get a discount. You can do this whether you’re paying for care in or out-of-network, or if you don’t have insurance. Williams says she has been able to cut up to 20 percent off of bills this way.

If you can’t pay cash, avoid paying with your credit card, which can end up costing you a lot in interest if you can’t pay off your monthly balance. Instead, call the billing department and ask for a zero-interest payment plan.

“I’ve done this multiple times for c-sections, hernia surgery, and gallbladder surgery,” says Williams “Every time, they’ve offered the option to pay the bill over a year, or more, if need be, at zero percent interest. They are always willing to work with you, you just have to pick up the phone and ask.”

Look into assistance programs

Hospitals, especially non-profit ones, often have assistance programs for uninsured or underinsured patients where they provide financial aid to patients based on their family size and income in reference to the federal poverty guidelines. (Underinsured patients are those who have coverage but still end up with high out-of-pocket expenses due to high deductibles or limited coverage.)

These programs require an application process and can take anywhere from 90-120 days to process, but can help completely pay for expensive medical bills.

Many hospitals also have catastrophic assistance programs. Even if a family doesn’t technically qualify for a standard assistance policy (as in they make above a certain household income), if the size of the bill is especially large hospitals will often make exceptions and write a large portion of the bill off.

“These programs can be very beneficial but are rarely advertised,” says Marrs. “Most people have no idea they exist.”

Seek out a patient advocate

Patient advocates are experts at navigating the healthcare system. They can help by taking on the burden of paperwork, negotiating, and making follow-up calls off the shoulders of a patient. “Oftentimes when someone has medical debt, they’ve experienced or are still navigating a difficult medical incident and need to focus on their physical and mental wellbeing,” says Marrs. “Worrying about expensive medical bills only adds to the stress, so having an advocate in your corner means one less thing to worry about.”

Some insurers cover access to advocacy services. There are also patient advocacy services that will charge a percentage of the amount they save you if they are successful. Nonprofits like Dollar For, whose mission is to help people navigate and eliminate their medical debt, don’t charge anything.

As much of a headache as it can be to make calls and negotiate, being persistent can often save you thousands of dollars. “Be kind,” says Marrs.

“Employees working in provider billing or insurance claims departments are often on the receiving end of angry rants,” Marrs adds. “Showing kindness goes a long way toward getting them to help you with your situation.”