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How To Negotiate A Medical Bill So You Don’t Pay Full Price

Sona Sulakian
Sona Sulakian Intern
A Bay Area native, Sona Sulakian is a rising 2L at USC Gould School of Law.
don't pay full price

Earlier this year, CNBC reported that 32% of American workers have medical debt and about 28% have a balance greater than $10,000. Many often assume medical bills aren’t negotiable, when they often are, before or even after treatment. 


Here’s how to go about negotiating your medical bill:


COVID-19 Testing and Treatment

Thanks to The Families First Coronavirus Response Act, COVID-19 testing is free. The CARES Act also included a $100 billion Provider Relief Fund to cover COVID-19 testing and treatment for uninsured patients. In many cases, however, the patient still bears the brunt of treatment costs. If you find yourself in this situation, you may be able to negotiate the cost of your treatment with your hospital or healthcare provider. 


Figure out the market value

If you know the care you will need, do some research beforehand. Ask your doctor for the name of the procedure, the billing code, diagnosis codes, and the expected cost of the treatment including any fees. Make sure the expected cost includes any follow-up visits, hospital stay, and any other associated fees. 


Then, compare this price with the market rate in your area. You can easily find the going price of a procedure on sites such as Healthcare Bluebook or FAIR Health Consumer


Finally, call your insurer and determine how much your insurer will cover, considering any deductibles, copays, and maximum annual or lifetime out-of-pocket expenses. 


Negotiate your hospital bill. 

Many bills are negotiable, especially those relating to COVID-19. 


Ask about any alternatives to paying in full, including any friendly payment plans. Try to incentivize the other party to lower the costs. For example, you can mention that you can pay faster if the fees are waived. Hospitals are often willing to set up monthly installment plans, sometimes without interest. 


Ask for the Medicare fees schedule. Determine what Medicare would pay the hospital for the same service. Medicare’s cost is often much lower than fees charged to market providers. 


If you negotiate a fee with any healthcare provider, make sure to get it in writing with a signature, either mailed or emailed. 


Ask for financial assistance. 

Many hospitals and providers are willing to help patients adjust the final costs, even after treatment. Many hospitals offer discounts to patients who are uninsured, whose insurance won’t cover the full cost, or who pay in full or in cash. 


Ask the hospital for any discounts, including the hospital’s charity care program which may fully cover your hospital bill. If you let the hospital know that you are struggling financially, the hospital may move you to a lower pay schedule. Usually, you will qualify if you make less than two times the poverty level, which is around $25k per year for a single person or $52k per year for a family of four. 


Don’t be afraid to ask for medical forgiveness if you have a hardship, including any financial hardships caused by COVID-19 or otherwise. Note that the provider or hospital may require tax returns or other written documentation to verify your hardship. 


If you need help, some companies like Medgotiate or CoPatient will negotiate on your behalf for a portion of the savings, usually 20-30%. 


Check your state’s billing protection laws. 

If you went to an in-network facility or hospital but were unknowingly treated by an out-of-network physician, you may be responsible for only the in-network cost. Bills charging the out-of-network cost are called surprise medical bills.  


Some states have “balance-billing” protection laws that protect patients against surprise medical bills. These states include California, Florida, and New York. 


In fact, the federal government has directed hospitals receiving emergency funds during the pandemic to treat every patient as a possible case of COVID-19 and has prohibited them from imposing any surprise medical bills on these patients.


Review your medical bills thoroughly.

Ask for an itemized bill. With your research in hand, go through the itemized bill and make sure the hospital charged the right amount, for the right procedure (checking the codes), and identify any duplicate or unreasonable charges, such as charges for medical supplies or hospital visits that you don’t recognize. 


What NOT to do.

Whether or not you negotiate, don’t ignore the bill. The last thing you want is to pay additional interest charges and risk your credit score falling, meaning higher credit card and loan interest rates. 


Remember, although you can now negotiate to lower your medical bill, place your health before any costs and don’t forgo any important medical treatments. 


Court Buddy is here to connect you with an experienced and trusted lawyer who can help you at an affordable rate. The company assists with the management of your case and lawyer relationship. Your lawyer will assess your legal issue in a timely and confidential manner, explain why you need or do not need a lawyer, and only charge you for the legal services performed and associated out of pocket fees. This article is intended to convey general information and does not constitute legal advice.


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