Part 2: Negotiating Your Medical Bills

In Part 1 of “How to Lower Your Medical Bills; The Ultimate Guide”, we provided background on how dangerously out-of-control medical costs have become, and walked through typical medical documents from hospitals and insurance providers to help you understand exactly what you’re being charged for — and why.

Now, in Part 2 of the ultimate guide, we’ll dive into the process of negotiating your medical bills. When learning how to negotiate medical bills, the process starts with gathering all of the right information, then recognizing problems that might be relevant to your specific case. Finally, we’ll guide you through what you can do to help reduce those bills.

There is no one-size-fits-all approach to appealing — and lowering — an exorbitant medical bill. While there are some standards around terminology and paperwork, hospitals and insurance companies tend to phrase or present things differently, often causing confusion (which may, in fact, be the point). For example, what the hospital bill calls the “insurance adjustment” may be referred to as the “plan discount” on your insurance company’s Explanation of Benefits. As we laid out in Part 1 of this guide, understanding those nuances is key to taking the next steps.

In order to start negotiating hospital bills, you need to dig deeper into why you’ve been billed a certain way. In other words, what particular issue (or issues) can you identify, whether it seems like price-gouging or an unexpected insurance denial?

In this part, we’ll identify the possible issues with your bill, dividing them into 4 buckets — Price-Gouging, Insurance Denial, Balance Billing, and Billing Errors — and providing detailed descriptions of each scenario and how to prepare for negotiating the bill. (Note: these buckets may seem dense and overly detailed. We’re trying to provide as much information as possible, as clearly as possible, so read carefully.)

Finally, we’ll help you apply that knowledge to the actual medical bill negotiation.

We recommend following this 3-step process for negotiating medical bills, which has led to significant bill reductions for our clients:

Negotiating Medical Bills in 3 Steps:

Step 1: Gather the RIGHT Information

(always more complex than it sounds)

Step 2: Analyze, Understand, and Fix the Issue

(less complex than it sounds)

Step 3: How to Negotiate Medical Bills

(requires patience, persistence, attention to detail, and a refusal to accept “no” for an answer)

Step 1: Gather the RIGHT Information

The first step to negotiating medical bills is to make sure you have in your possession — and that you understand — all of the relevant documents for your case. (For a refresher on how to understand your hospital bill and insurance Explanation of Benefits, reread our section in Part 1: Understanding Your Medical Bills.) These medical documents include:

  • Hospital Bill
  • Itemized Hospital Bill
  • Explanation of Benefits (if you carry insurance)

Hospital Bill

Your hospital bill is typically sent to you in the mail. It comes from the hospital and lists total charges along with any discounts offered, insurance company coverage, and what you as the patient owe.

Itemized Hospital Bill

This is a breakdown of all charges, line by line. This won’t be sent automatically; you have to call the number on your hospital and ask specifically for the Itemized Hospital Bill. Hospitals aren’t inclined to provide this information, but they are required by law to do so if you ask. Make sure to be clear and direct, and say something along the lines of “I would like an itemized bill.”

The itemized bill should have a line-by-line list of the charges and the associated “revenue code” (the internal code the hospital uses to determine their charge), the CPT or HCPCS code (used to identify what services were provided), and charges for each line item.

Explanation of Benefits (EOB)

If you have insurance, your insurance company should have sent this to you. If your insurance company has an online portal, it’s almost always posted there. Additionally, you can call your insurance company and ask them to send an EOB to you.

If you don’t have insurance, don’t worry about this document.

Note: If it feels frustrating and difficult to gather even these three simple documents, don’t worry — this is a very time-consuming process, even for us. It’s upsetting that something that seems so simple ends up being so complex and time-consuming. However, remember: be patient, persistent, and do not accept “no” for answer.

Step 2: Analyze, Understand, and Fix the Issue

Most billing issues that we encounter fall into 4 different buckets (described below). It’s important to understand which bucket you fall into (though it may be more than one) so that you take the right path to rectifying the situation.

(If you’re unclear that any of these 4 buckets apply to you, it’s likely you have a more complex case. Contact us directly to make an appointment with one of our experts, who will be happy to spend 20 minutes going through your situation and to point you in the right direction.)

What follows are descriptions of the 4 buckets or medical billing situations patients often find themselves in including how to identify it and guidance on how to fix it:

Price Inflation

Description:

Price inflation is the hospital charging you far more than fair market price for services provided. As mentioned in Part 1 of this guide, hospitals charge consumers, on average, 4.2 times their actual costs and 3.5 times the price that insurance companies pay for the same service (the price insurance companies pay is negotiated behind closed doors).

Bottom line: if you don’t have insurance, the price that you’re being charged by the hospital is almost certainly inflated.

How to identify price inflation:

As mentioned above, if you don’t have insurance, the hospital is likely charging you their rack rates for services, which means you’re almost certainly being price-gouged.

If you DO have insurance but don’t see a Plan Discount on your Explanation of Benefits (EOB) from the insurance company — or if the Plan Discount is for a very small amount relative to the total charges — you may be getting price-gouged. In this case, call the insurance company to walk you through the bill and confirm that the Plan Discount amount is correct.

How to fix price inflation issues on your medical bills:

While many people may shy away from negotiating hospital bills based on price, this is exactly what you should do. You need to ask the hospital to reduce the price they’re charging to a more reasonable amount (inline with what insurance companies pay, not the ridiculously inflated Chargemaster rate).

Beware: simply calling the billing office and demanding a discount will usually result in being told to apply for financial aid or to “get on a payment plan” — the front lines of hospital billing staff don’t want (and often aren’t authorized ) to lower the actual amount you’re being charged.

More work needs to be done in order to get a hospital bill reduction. Fortunately, we offer a better set of strategies to help you get the results you need.

Here are 3 steps to follow in order to resolve price gouging issues on your medical bill:

  • Step 1: Build Your Case
  • Step 2: Submit a Settlement Request
  • Step 3: Start Negotiating (if your settlement offer isn’t accepted)
Step 1: Build Your Case

Simply asking a discount often isn’t enough. We want to not just make the request but also give the hospital a strong reason to accept a lower amount, which we do in two ways:

  1. Arguing that the amount billed creates a financial hardship
  2. Pointing out that the prices being charged are far out of the ordinary (and comparing to what ordinary or reasonable prices might be)

Arguing that the amount billed creates a hardship gets easier and more believable as the bill gets larger. There’s no need to provide detailed financial records. Rather, simply state that you have multiple bills related to the procedure (as long as this is true) and that everything together makes it very difficult to pay.

Showing that prices being charged are out of the ordinary requires a bit of research. One of the best ways to do this is to look up Medicare reimbursable pricing, or sign up for a free trial of Find-A-Code, where you can enter the HCPCS/CPT code from your itemized bill and see what a Medicare reimbursable rate would be. Insurance companies generally pay 1.5 to 3 times the Medicare reimbursable, so it’s best to use that range as your initial offer.

Another way to identify a reasonable rate is to identify what’s known as the charge/cost ratio of the hospital (this is essentially the mark-up the hospital puts on their services) and use this to determine what a fair price might be. Unfortunately, government-published datasets are very difficult to work with, and private companies charge a lot of money for this information. Nevertheless, it may be worthwhile to conduct a Google search of “charge/cost ratio [hospital name]” to see if you can find anything informative.

Step 2: Submit a Settlement Request

Now that you’ve built a case, it’s time to submit a settlement request.

Submitting the request is the starting point for negotiations — and the best way to steer the conversation with the hospital away from a possible payment plan — but it is not the end-all, be-all.

In order to do this, all you need to do is write a settlement request letter. This letter gives the hospital something to respond to, and, more importantly, it forces them to start talking about price and not just payment plans or applying for financial aid.

Your settlement offer letter should include the following information:

  • Your account number
  • Your name and address
  • Dollar amount outstanding (that is the amount still on your bill)
  • Dollar amount you’re offering to pay for services
  • Reasoning for the dollar amount you’re offering to pay (generally based on Medicare Reimbursable rates or Charge/Cost Ratios)
  • That you’re willing to pay the proposed amount immediately up front (if you can), which encourages the hospital to accept your offer
  • Thanking the hospital for their services

Proofread the letter to make sure all of the information is correct and that there are no spelling or grammatical errors. It’s important that your letter look as professional as possible.

Now it’s time to submit your letter. Call the number on your hospital bill and ask how you can submit a settlement request. They should provide a fax or email.

Note: You may be asked whether you want to go on a payment plan or apply for financial aid. Many hospitals accept settlement requests but billing department employees are trained to redirect to other methods. Stand firm in asking about how to submit a settlement request.

A day after you submit the letter, call the hospital to confirm that it was received and ask how long it will take for them to respond. You may have to call back multiple times over the next week to confirm receipt, but make sure you do. A favorite trick of hospitals is to “lose” your settlement request. Don’t let them do this, and don’t be deterred by roadblocks. Patience and persistence are key.

3. Start Negotiating

Keep checking on the status of your settlement request until you receive a response. As a general rule, hospitals will not call you back unless you push them.

If the hospital accepts your initial settlement offer, congratulations! You’ve successfully negotiated and all you have left to do is pay the bill.

If the hospital denies your settlement request, realize that this is just the start. Ask for a reason why and if they can provide a counteroffer. You may also request to speak to a supervisor to make your case over the phone. If they continue to deny, thank them and then try again in 3-5 days. (This method of keeping at it has resulted in significant discounts for us in the past.)

This often ends up being a long process of requesting a discount, being told no, and then trying again.

If after a lot of patience and persistence, you’re still getting nowhere — give us a call (877-245-4244) because we may be able to provide guidance or help “unstick” the situation.

Insurance Denials

Description:

The insurance company refuses to pay for a medical procedure, even though you went to an in-network hospital, sticking you with the bill. Often your insurance company will deny coverage for one of two reasons:

  1. The medical procedure wasn’t covered under your insurance policy, or
  2. The medical services provided weren’t for a medical emergency

Because algorithms are typically used to sort claims and issue denials, we often see erroneously denied claims that should obviously be covered.

In one instance, a patient went to the ER with severe chest pains (thinking that they might be having a heart attack), only to be diagnosed with acute heartburn. The insurance company denied their claim because acute heartburn is “not a medical emergency.” The denial was overturned, as the reason for going to the ER — a potential heart attack — presented a medical emergency, and is separate from the actual diagnosis.

How to identify:

Your Explanation of Benefits (EOB) from the insurance company should clearly state both if your claim was denied AND the reason for your denial. It’s important to note the reason for denial, as that determines the best path to appealing your claim.

How to fix:

Appealing insurance claim denials is all about attention to detail, following the process to a T, recording everything, and patient yet persistent follow-up.

Many health insurance companies have deadlines for filing appeals so make sure to act fast to get the appeal out the door and into the hands of the insurance company.

If your claim was denied because of a clerical error (e.g. misspelled name, wrong insurance ID, etc.), it should be relatively straightforward to fix. Call up your insurance company and ask for the forms to refile. Be extremely careful and deliberate to make sure there aren’t any mistakes on your refile.

If your claim was denied for another reason (likely either because the treatment received was not a covered procedure or not a medical emergency in the eyes of the insurance company), we recommend taking the following steps:

Step 1: Understand the Process and Paperwork

There’s a lot involved in filing a claim appeal so it’s important to track everything carefully.

You should be able to find all paperwork and the process for filing an appeal in your insurance company’s online portal. If you’re still confused, call up your insurance company and ask directly.

We recommend writing out a step-by-step process and a checklist of all the paperwork needed at each stage of the process. This allows you to track your progress and ensures that you have everything needed to properly file an appeal. Additionally, putting all forms in one place (a folder on your computer or in the cloud, or a hard copy near your desk) makes it easy to find and work on your case.

Step 2: Gather All Evidence

Work with your doctor and the hospital to gather the relevant evidence that will allow you to overturn your claim. Depending on your individual case this could include:

  • Referral from your doctor to another medical provider
  • Medical history records to show a treatment or procedure was a medical necessity
  • A note from your doctor affirming medical necessity (doctors and hospitals are usually very happy to provide this to you if you call them up and ask)
  • Adjustment to diagnosis and treatment codes — sometimes the billing department enters incorrect codes that aren’t covered by your insurance. If this is the case, request that they change those codes to items that are covered.
  • Explanation of covered procedure — if you believe that your procedure is actually a covered procedure, include an explanation of this (along with a note from the doctor)
Step 3: Submit Your Appeal and Follow Up

Now that you’ve gathered the evidence, submit your appeal claim form.

Make sure that you read the claim form extremely carefully and follow each step exactly as it’s written. Any mistake can cause your appeal to be denied due to clerical error, forcing you to go through the process of filling out everything again.

We recommend politely calling your insurance company every couple of weeks to check on the status of your claim.

While you shouldn’t be under deadline pressure at this point (deadlines are usually for filing the claim, not the insurance company response time), appeals can take time and it never hurts to check in on the status and see if there’s anything else to be done to expedite the process. Make sure you also ask for an expected timeline for the appeal to be processed.

Two important items to keep in mind when following up:

  1. Take notes. Every time you call, write down the date and time, the name of who you spoke to, what you asked, and what their response was.
  2. Don’t shoot the messenger! The person you’re talking to on the phone is not the same person responsible for filing and making a decision on your appeal. If you don’t get the response you want or things are taking a long time, remain polite and ask what you can do to change things. You want to make the person you’re talking to your advocate in getting the process done — getting angry never helps.

Balance Billing

Description:

Balance billing is the hospital billing you for the difference between the amount your insurance company paid and their Chargemaster rates (that is, billing you the Contractual Discount on your EOB/Hospital Bill).

As described in Part 1, your insurance company negotiates special rates with the hospital. As part of the agreement, the hospital is NOT allowed to charge those insured the difference between their standard rates and the negotiated rates. However, sometimes they do anyway (mistakenly or otherwise).

Balance Billing Example:

$75 Standard rate of towing service without AAA
$45 Pre-negotiated rate between towing service 
and AAA
$30 Bill you receive for difference between standard rate & pre-negotiated rate. 
This is Balance Billing.

If that’s still confusing, here’s an analogy to help put it into perspective. Say you have AAA and need to get your car towed. Your contract with AAA provides free towing. AAA arranges and pays for the towing service, and a truck from Acme Towing comes to tow you. Acme and AAA have a pre-negotiated rate for towing services (say $45), but this rate is less than what Acme generally charges for people who don’t have AAA (say $75). So in order to make more money, Acme collects the pre-negotiated amount directly from AAA ($45), and then bills you for the difference between what AAA paid and what their standard rate is ($30). Pretty slimy, right?

Not to make things more confusing, but there are two types of balance billing: In-Network and Out-of-Network.

In-Network Balance Billing occurs as described above: the insurance company and the hospital have a contract defining a set rate for services, and the hospital attempts to bill you extra on top of that defined rate (which is not allowed in their contract).

Out-of-Network Balance Billing occurs when you go “out-of-network” for your medical treatment. That is, the medical service provider does not have a negotiated price agreement with your insurance company. In these cases, the insurance company determine on its own what it will pay the hospital for these service. There is no contract stating that the hospital cannot charge the patient the difference between what the insurance company paid and the hospital charge master rate (though many states have laws regulating what can be charged in this instance – we’ll get into that in the next section).

In the towing company example, AAA and Acme would NOT have a pre-existing agreement. Instead, AAA would just pay Acme $45 even though Acme normally charges $75.

How to identify:

Compare your Explanation of Benefits (EOB) from your insurance company with the bill that your hospital sent you.

The EOB should clearly tell you whether the healthcare provider is in- or out-of-network.

Additionally, if the numbers from your EOB and Hospital Bill don’t line up, you may be getting balance billed.

In-Network

The “Balance” on your Hospital Bill should match the “Patient Portion” (or amount owed) on your EOB.

If they don’t match, and/or the Balance on your Hospital Bill matches the “Contractual Amount” or “Plan Discount” on your EOB, you may be getting balance billed.

Out-of-Network

If you go to an out-of-network healthcare provider, your EOB will point this out. It will also list the Gross Charges from the hospital and the amount that your insurance company paid the hospital or doctor’s office.

The hospital will likely send you a separate bill for the difference between their Gross Charges and what the insurance company covered. This is the “Balance” in Balance Billing.

Even if you went to an In-Network hospital for your medical treatment, it’s possible to have Out-of-Network charges. It’s increasingly common for certain doctors or departments at “in-network hospitals” to be separate from the hospital, not have an agreement with the insurance company, and therefore be considered “out-of-network.”

How to fix:

As mentioned earlier, there are two types of balance billing: In-Network and Out-of-Network.

We’ll walk through these situations one by one, but feel free to skip to the section that’s most relevant to you:

In-Network

Fixing in network balance billing is relatively straightforward, as this almost always goes against the contract the hospital has with your insurance company. There are 3 steps to follow:

Step 1: Call the Insurance Company 

Before working with the hospital, we recommend calling your insurance company to walk through your Explanation of Benefits (EOB) and Hospital Bill, and to accomplish 2 things:

  1. Confirm that you are, in fact, being balance billed. Your insurance company representative should be able to walk through your charges and what you’re responsible for and confirm whether this is the case
  2. Ask the representative the best way to talk to the hospital about getting the balance billing reversed. In-Network balance billing is forbidden in the contracts that insurance companies have with hospitals, so they will know how to correct this (and may do it for you).

Step 2: Correct with the Hospital

  1. If your insurance company didn’t offer to reach out to the hospital to correct the issue on your behalf, call the number on your hospital bill and let them know that you spoke to the insurance company, believe you’re being balance billed, and request that they correct it.
  2. You may have to walk through everything carefully to show that you’re being balance billed (which is why it can be helpful to walk through this with your insurance company first—so you’re more confident in what’s going on).
  3. It’s important to NOT threaten anything at this stage — regardless of whether this is contractually forbidden or even illegal. Most of the time, balance billing is a clerical error on the hospital’s part and they’re more than willing to work with you on it. Don’t turn the hospital into the enemy.

Step 3: Get an Updated Hospital Bill 

Make sure you request that the hospital send you an updated and corrected bill — so you can have the change in writing. Once this is done, make any payments you still owe (which, depending on your insurance, could be a deductible or copay).

Out-of-Network

If the hospital that provided treatment is an “out-of-network” medical provider you can no longer use your insurance company for help. However, many states have laws prohibiting balance billing from out of network providers.A recent overview of state laws was published here.

We also recommend conducting an online search “balance billing laws [your state]” to ensure that you have the most up-to-date information.

Note: you will likely need to spend some time reading and understanding the laws as they may or may not apply to your specific situation.

If your state has good out-of-network balance billing laws, you can use those to reduce the amount you owe to the hospital. Call the hospital up and politely state that you think you might have been balance billed against state law and ask to speak to someone about it (it’s unlikely that the person answering the phone will have the authority to make changes). Once you get the right person on the phone, walk through your argument in detail. If you are being illegally balance billed, the hospital should be able to easily correct it.

Note on contacting an attorney: Depending on the size of the bill and your laws, it may be worthwhile to contact an attorney. Attorneys are skilled at helping you navigate and understand laws on the books. But keep in mind that they usually charge a high hourly rate, so you’ll need to find significant savings to make up for it.

If your state does NOT have comprehensive balance billing laws, the path forward is a little trickier.

We’ve had success in the past by convincing both the insurance company and the hospital to treat this as an In-Network claim.

This means that the insurance company pays “in-network rates” for services provided (which are usually more than out of network rates), and the hospital agrees to accept these “in-network rates” as payment-in-full for the services provided.

Convincing insurance companies can be a little tricky, since essentially you’re working to convince them to pay more money than they otherwise would. So you’ll want to make the following assertions:

  • Your portion of the current bill is large enough that it could cause you to go bankrupt (provided it’s true)
  • You would have gone In-Network if you had the chance, but did not have the option (especially effective if you had emergency services)
  • Given the above, you won’t be able to afford to continue as a customer if this isn’t treated as an In-Network claim

Once you get your insurance company on board, you want to work with the hospital to get them to agree to treat this as an In-Network amount. Sometimes it’s enough just to connect the insurance company with the hospital and let them hash it out. However, if you need to talk to the hospital, keep in mind the following points:

  • Accepting as an In-Network claim will provide them with a fair rate for the services provided
  • The current bill might bankrupt you (provided this is true), so the hospital will end up getting more money if they agree to treat as an In-Network claim

Because there are no laws or contractual obligations governing behavior, this can be a tricky and nuanced process. You’ll need to stay calm and patient, and try to get the person on the other end of the line to see your point-of-view while understanding theirs.

Billing Errors

Description:

There are two types of billing errors:

Charges for Services Not Provided: These are charges for services you did not receive. This could be anything from charging for 10 extra aspirin at $50 each to going in for heart surgery and being charged for a knee replacement on top of it.

Hidden Charges: This is slightly more complex and difficult to verify. There are two major hidden charges: unbundling and upcoding.

  • Unbundling is taking a procedure that has a single code and also adding in the codes for all elements of that procedure. For instance, you may have been billed for a “panel” of tests  (e.g. arthritis panel). But if you see every individual test in the panel also being billed, the hospital is unbundling.
  • Upcoding is the practice of putting a code on the bill for a service that is more complex (and likely more costly) than the services actually performed. For example, ER visits are graded on a 1-5 scale based on severity. Using the code for a level-5 ER visit, when the severity is actually level 4, would be upcoding.

How to identify:

Charges for Services Not Provided: Look through your itemized bill line-by-line to make sure you remember being provided all of the services listed. If you’re unsure of any of those services, you may want to consult your Electronic Medical Record (EMR). You can call the hospital to request this (specifically state that you want them to send you your Electronic Medical Record. They are required by law to do so when asked directly).

Start with the largest charges first. The descriptions can be confusing, so Healthcare Blue Book and Google searches are your ally. Take the HCPCS/CPT code (there should be an identified column) and run a Google search to get a description of the code. There will almost certainly be tests and minor procedures that are unfamiliar to you—so, again, start by looking for large procedures that you’re sure didn’t happen.

It’s possible to go through every charge, line item by line item, and compare it to your EMR—though the amount of medical jargon can be extremely intimidating. As long as you’re able to ensure that the most expensive items are correct, you should mostly be covered.

Hidden Charges: For unbundling, we recommend signing up for a free trial of Find-A-Code. Use the NCCI Edits Validator (under the Tools menu) and enter all of the codes on your itemized bill. Find-A-Code pulls from government-published CMS guidelines to detect code pairs that should not go together (because that would be unbundling). Make sure that your entire hospital bill comes back clean. And if there are any errors, call your hospital’s billing department to discuss them.

Upcoding can be a little trickier and requires more intimate knowledge of medical coding and procedures to really dig into. For ER visits, the severity level should be clearly identified (and if not, googling the CPT code will help). The American College of Emergency Physicians has a good breakdown and explanation of what constitutes various ER visit levels.

How to fix:

Once you’ve identified the billing errors, call the hospital’s billing department and say that you have questions about your bill and would like to speak to someone about it.

Go line-by-line through the items on the bill that you think might be errors, and explain why you think they are errors.

Remember to remain patient and calm throughout, as you may have to explain things multiple times to multiple people.

Step 3: Negotiate

The bottom line is, negotiation isn’t easy, and it isn’t for everyone. But we can offer some tips on how to be a better negotiator and (hopefully) achieve a better outcome.

Write Everything Down

Record ALL of your conversations in one place and save them — ideally in the cloud (e.g. Google Drive or Dropbox) so you can access them from anywhere. Make sure to include the date, who you talked to (ask for their names), what the discussion was about, and any responses to questions you may have had.

The hospital and insurance company are taking notes on your conversations — so you should too. The goal isn’t to have a “gotcha” type of moment, but rather to quickly and easily be able to go back and review all conversations so you can understand exactly what’s going on.

Find an Advocate

As you call the insurance company and hospital and record more and more names, you may find yourself talking to the same person multiple times or someone who seems to be very focused on helping you out. Your goal should be to get them on your side, advocating for your case internally. Oftentimes, finding an advocate at the hospital or insurance company is the key to unlocking savings.

This is why we say be polite and patient, yet persistent. It’s difficult to find an advocate if you yell or swear, and the more you become familiar to the person on the other end of the phone (by reaching out multiple times), the more comfortable they’ll feel going out of their way to help you out.

Separate People from the Problem

Remember, no matter how frustrating the process may become, the person on the other end of the line is not your opponent or your enemy. Instead of being accusatory (“You did this” or “You did not”), phrase your words in terms of what the bill says or “what I’ve been told” more generally. Remaining calm, stay focused on the issue at hand: lowering your medical bill.

Persistence — Don’t Take “No” for an Answer

The answer and outcome you want may not come right away or on your first try. Be polite, patient, and keep trying. Often enough, it’s a matter of asking a question the right way, or it may take finding the right person on the other end of the line to be motivated to help. (Your politeness is motivating.) Whatever you do, don’t give up.

Summary

  • The first step to negotiating your hospital bill is making sure you’ve collected all the relevant documents for your case, including your hospital bill (along with an itemized bill that you may have to request from the hospital) and your insurance company’s Explanation of Benefits. Reread Part 1: Understanding Your Medical Bills for a refresher on how to make sense of the information on these documents.
  • The second step is identifying the particular billing issue (or issues). Most billing issues fall into 4 different buckets — Price Gouging, Insurance Denial, Balancing Billing, and Billing Error. Gaining a detailed understanding of the issue that applies to your bill is key to taking the next step: negotiating.
  • If you’re unclear that any of these 4 buckets apply to you, it’s likely you have a more complex case. Contact us directly to make an appointment with one of our experts, who will be happy to spend 20 minutes going through your situation and to point you in the right direction.
  • Negotiating isn’t easy, and it isn’t for everyone. It requires patience and an ability to remain calm and polite throughout a process that’s likely to include multiple phone calls with multiple people on the other line. With persistence and a high level of organization (of your time and your paperwork), we’ve seen many customers successfully lower their medical bill.

Back to Part 1: Understanding Your Medical Bills

Go to Part 3: Getting Help with Your Medical Bills