You Can Negotiate A Medical Bill. Here's How.

You've read a story like this and just shake your head:
Alexa didn’t want her upcoming vacation trip ruined by strep throat. So, after it had lingered for more than a week, she decided to get it checked out and visited her primary care physician.
The visit was quick. Alexa got her throat swabbed, gave a tube of blood and was sent out the door with a prescription for antibiotics. She soon felt better and the trip went off without a hitch.
Then the bill came. Read the full story.
Total Bill: $28,395.50 for an out-of-network throat swab. Her insurer cut a check for $25,865.24.
$28,395.50!
I hope you never have to deal with a situation like this one. It does happen and you should be prepared for the upcoming medical procedure you have scheduled or any emergency medical need you may have. There are several strategies both before and after receiving medical services to protect yourself from high medical bills.
First and foremost, understand the health insurance and supplemental insurance plans you have. Know the amount of deductibles, co-insurance, and co-payments on the policy. Your insurance agent and the insurer should provide a full explanation of limitations and exclusions and a summary of benefits when you apply for and are approved for coverage.

Negotiate before treatment begins

Under certain circumstances, say an emergency room visit, you’re not going to have much say in the cost of your treatment. But if you’re getting a planned surgery or procedure, then it’s possible to negotiate your medical bills before you undergo treatment.
  • Get in touch with the hospital’s billing department to get an estimate of how much your procedure will cost
  • Present this information to your insurance provider to get an estimate of what your plan will cover
  • Once you know how much you’ll be responsible for, have a candid conversation with your hospital’s billing department to let them know how much you can afford.
  • The billing department may recommend setting up a payment plan or applying for payment assistance programs, depending on your situation
Don’t be afraid to ask questions like, “Is this procedure necessary?” or “How much will it cost?” After all, hospital procedures are still transactional, and you are the customer. Call your health care provider rather than emailing them. It’s much more efficient to negotiate medical bills over the phone than over email. Make sure you write down the time and date of your phone call, as well as the name of any representatives you speak with.

Shop to find cheaper providers before your service

It’s common for insurance companies to offer cost estimates for services. If your insurance provider doesn’t offer this service, you could try a third-party website, like Healthcare Bluebook and GoodRx for prescription medications. These free tools allow you to compare the cost of treatment and prescription medicines.
Before your treatment, make sure all labs, anesthesiologists and other ancillary services that your provider uses are in-network.
I highly recommend you visit both of these websites. Healthcare Bluebook enables you to search for medical procedures and providers in your area. You can then compare providers to find the best quality of care at a fair price.
Negotiate after treatment
Request an itemized bill and check for errors.
After your care, you’ll receive an Explanation of Benefits (EOB) from your insurance company and a statement from your health care provider. An EOB is not a bill, and it may be updated as your claim is processed. Never pay an EOB without receiving a bill from your provider and without reviewing it for errors.
Consider reaching out for help. Numerous health care and medical billing advocates are out there, such as the Patient Advocate Foundation. The downside is that many of them cost money, too. Still, they'll go to bat for you if you're not getting anywhere on your own, and some offer sliding-scale fees based on your income.
The final word on Alexa: She did pay her usual $25 copay for the office visit, and a $9.61 fee for a separate set of lab tests.
It was very much worth her while to negotiate this medical bill.


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