How to negotiate a medical bill

Step by step

1. Don't pay right away. Confirm the bill is yours, the service happened, and it hasn't already been paid by you or your insurer.
2. Ask for an itemized bill that lists every charge, not just a total.
3. Compare it with your Explanation of Benefits (EOB) if you have insurance. The amount you owe the provider should match what the EOB says is your share.
4. Look for errors (list below) and dispute them in writing as soon as possible.
5. Ask about financial assistance and get the application.
6. Make an offer. Ask for a prompt-pay or cash discount, or the rate insured patients get. Be specific about what you can pay now.
7. Get any agreement in writing before you pay, including a zero balance or the payment plan terms.

Billing errors to look for

• The same service or treatment charged twice.
• Care you never received, or a date of service when you weren't there.
• Amounts already paid by you, by your insurer, or covered by financial assistance.
• A bill meant for someone else, such as a patient with a similar name.
• An out-of-network bill for emergency care or for a provider at an in-network hospital, which the No Surprises Act generally limits.

Dispute early and keep notes of every call: the date, who you spoke with and what they said.

Hospital financial assistance (charity care)

Under IRS rules (section 501(r)), every nonprofit hospital must have a written financial assistance policy covering emergency and other medically necessary care. It must say who qualifies, whether help is free or discounted, and how to apply, and the hospital must post the policy, application and a plain-language summary on its website.

• Price limit: if you qualify, the hospital can't charge you more than it generally bills insured patients for emergency or medically necessary care, and must charge less than its full list price.
• Time to apply: you generally have 240 days from the first bill after discharge.
• Collections pause: the hospital must wait at least 120 days from that first bill, and give 30 days' written notice, before actions like credit reporting, lawsuits, liens or selling the debt. If you send a complete application, it must suspend those actions until it decides.

Hospitals that aren't nonprofits may have their own programs. Ask the billing office either way.

Payment plans and credit cards

Ask whether the provider will accept an interest-free payment plan you can afford, and get the terms in writing. Be careful about putting a large medical bill on a credit card or a medical credit card: interest can be high and you lose leverage to negotiate.

If you're paying without insurance, and where to get help

If you're uninsured or chose not to use insurance, ask for a good faith estimate before scheduled care. If the bill comes in at least $400 above that provider's estimate, you can start a federal dispute within 120 calendar days of the first bill. See the No Surprises Act for the steps.

If you can't resolve a billing dispute, you can submit a complaint to the Consumer Financial Protection Bureau, your state insurance department or your state attorney general. Gabriel Plus has member prices close to cost on lab tests, supplements, prescriptions and bioregulators. Gabriel is a membership, not health insurance.