How To Negotiate Medical Bills

By Brandi Savitt – September 2, 2011

The Squeaky Wheel Gets the…Discount

A few months ago, a dear friend of mine had to have a routine outpatient surgery.  The surgery went well, but she was slow to recover, and after hours of trying to regulate her vitals, the doctors decided to admit her so they could monitor her progress through the night.  The next morning she was bright eyed and more than ready to go home.

It was not until a couple weeks later that her insurance statement arrived…  For one night in the hospital – with no special treatment – the hospital charged the insurance company $50,000!  However, the insurance company’s records indicated that they had paid only $17,000 (still outrageous).  Was my friend responsible for the rest of the bill?  Thankfully, in this case, no!  The insurance company actually negotiated the bill down on their own behalf.  That’s when I realized – if insurance companies are negotiating with hospitals and doctors – shouldn’t we all be?!

Fight for Your Right to Affordable Healthcare

Whether you have a ‘good’ health insurance plan or no plan at all, you have a right to pay a fair price for your medical care.  However, whether you are going in for a routine procedure, or you are dealing with a chronic disorder, the patient is often left in the middle to deal with the financial dance between doctors, hospitals and insurance companies.  And ultimately, it is the patient who must pay.  So, in the hopes of making self advocates out of all of us, we went to the experts for some negotiating advice.  From billing department employees to lawyers to patients themselves, we gathered some Fab & Fru tips to help heal your mind, body and your wallet!

Get Pre-Certified Before Having a Procedure

If you have insurance, and it is not an emergent procedure/surgery, ALWAYS call to check your coverage ahead of time.  Staying in your network can drastically reduce your costs.  You may also need to”pre-certify” a procedure to be able to access your full benefits.  Afterward, go over your insurance Explanation of Benefits (or EOB) carefully to make sure that they’ve covered everything that they should have.  Familiarize yourself with your deductible, copay/coinsurance amounts & benefit maximums.

Doctors Don’t Want to Sue

It turns out doctors also have a financial incentive to avoid a collections hassle.  According to Washington DC based attorney Thomas J. Simeone, Esq, “If the medical provider retains an attorney or collection agency to collect the outstanding balance, it will likely pay approximately 1/3 of the amount recovered as a legal fee. That is the average legal/collection. Therefore, if you negotiate directly with the provider before the provider involves a third person, you have a good chance of getting up to a 1/3 reduction at the start.”  Who knew?!

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5 Responses to “How To Negotiate Medical Bills”

  1. Kim says:

    Another extremely helpful and informative article…thank you SO much!!!!

  2. Maureen says:

    Here’s some other tips for checking your medical bills:

    * Always make sure you have an itemized bill, not a summary bill.

    * Make sure the date of service is correct.

    * Double check quantities and description of services.

    ** If something doesn’t make sense or doesn’t look right, question the
    items on your bill. Be Your Own Advocate!

  3. sylvia says:

    Last year I spent the entire year going back and forth to a specialist for pulmonary hypertension. Towards the end of the year I had a procedure done on an outpatient basis. That procedure was over $45,000. My insurance paid all but approximately $2,000. Besides all the other doctor/lab bills, etc. I had to pay during the year to be hit with that bill threw me for a loop. I sent $100 a month to the hospital and when I sent my first $100, I included a letter stating that I wasn’t able to pay the entire amount off at once, but would make payments. I continued to make payments as I had promised to do. Several months later, I rec’d a letter from a collection company stating that the hospital had turned my account over to them. When I called the hospital and asked why and explained I was sending them $100 a month, they told me I had to speak to a person in their financial department and the letter wasn’t acceptable. Not once did they let me know my letter wasn’t acceptable, they continued to take my money. When I questioned an amount that appeared on the bill they turned over to Collections, an amount that was from earlier in the year when I first started seeing the specialist, I was told that the hospital had up to FOUR YEARS to bill me. Can you imagine my frustration. They have four years to bill me yet they turned my account over to Collections. So now I am paying the Collection Company and they told me that $100 wasn’t enough to send in and they would review my account again after three months (still taking my $100 a month). Very frustrating.

    • Pani Dan says:

      hi, Sylvia!
      I am sooo sorry to hear about the added stress! I had a similar situation, involving collections agencies. Long story short, I was unable to resolve on my own. I had an attorney help me who I DIDN’T HAVE TO PAY! Yes, it’s true! There’s some thing in the law which makes them pay her fees on top of anything settled for you. so it was SO worth it – I ended up getting it all fixed and no stress for me. But whatever you do – keep all paperwork. I didn’t and it took longer to gather everything. Letters from collections, hospital, copies of your checks, etc. I don’t know where you are located or where the collection agency is, but you can email my old attorney at help@ – tell her that Pani Dan sent you – she’s very nice and personable. not a “normal attorney.” lol

    • Wendy says:

      Get some visibility in your newspaper or the consumer advocate on TV in your area. That seems to make these people get things resolved quickly.

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