How to negotiate a medical bill


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If you’ve ever had to deal with expensive medical bills or delayed going to the doctor because you can’t afford the cost, you’re not alone. Nearly one in three American adults has medical debt, according to a survey. In the United States, it is estimated that there are more than 140 billion dollars nationwide medical debt. There are more medical debt in collection than any other type of debt.

When you receive your medical bill as a result of an office visit, diagnostic tests, or more important procedure, you might be surprised at how much you have to pay, whether or not you have health insurance. It might seem intimidating, difficult, and time consuming to dispute the invoice you just received, but it could mean saving hundreds or even thousands of dollars.

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1. Understand your medical bill

The first step in disputing a medical bill is determining what you were billed for. Interpreting a medical bill is like learning how a credit card or checking account works, Allen explains.

“We know we need to check our credit card statements because mistakes on them can cost us hundreds or thousands of dollars,” Allen said. “In healthcare, mistakes can cost us a lot more. And if you talk to experts who study medical bills for a living, they will tell you that most of them contain some type of error. . “

Some estimates claim that almost 80% of medical bills contain some type of error. After you receive your medical bill, you’ll want to request an itemized bill.

Your itemized bill will give you a list of billing codes for all services provided by your doctor. These billing codes are known as Current Procedural Terminology or CPT codes. CPT codes are five-digit numbers used to encode and describe health care services and procedures. They are used by public and private health insurance organizations and health service providers.

If you have insurance, you’ll also want to make sure the claim has been submitted to your insurance company and that the prices are what you owe after the insurance company has negotiated with the medical provider. (Note: If a healthcare provider is considered ‘networked’ for your plan, that means they’ve negotiated a reduced rate with your insurance company, so you’ll usually end up paying less when you go. to providers in your network.)

In order to understand what your CPT codes mean, you can search for them online. the American Medical Association keeps the complete and protected set of CPT codes. Individuals are allowed up to five free CPT code searches per day via the website. Do a search for 99395 and you will see that this is a preventive medicine visit for a person between the ages of 18-39.

You will then need to make sure that the services you have received correspond to the CPT code indicated on the invoice. Doctors sometimes “upcode” patients, Allen said. “Encoding” occurs when a patient is billed for a more complicated service or procedure than the one they actually received, he says.

Office or emergency room visits can vary in complexity from a Level 1 to a Level 5, with Level 1 being the least complicated and Level 5 being the most complex, he says. Generally, the higher the level, the higher the cost.

“A level 3, 4 or 5 emergency room visit requires a thorough examination on your part, and requires a thorough history, therefore [the doctor] knows all your other health problems, all the different medications that you are taking. It also requires medical decision making which has a certain degree of complexity, ”says Allen. “In other words, it requires intensive care. “

If you have the impression that you have been “upcode” or that the codes on your invoice do not correspond to the services you have received, you should contact the invoicing department and explain to them why the services you have received are not. reflected. in the invoice you received.

2. Gather evidence and challenge the bill

In order to successfully negotiate your medical bill, you may need proof that the care provided by your doctor does not match the services you are billed for, Allen explains. You can submit a request for a medical record of your visit to your doctor’s office or to the hospital.

There may be additional charges for your medical records, but sometimes you can negotiate with them, he says. You can also ask your primary care doctor directly to share them with you.

Once you’ve got your medical records, you can use them to support your case, Allen explains. For example, you can show notes in your medical record to show that you have been billed for a medical visit requiring medical decision making while your doctor’s notes show no evidence of this type of care.

If the billing department is unwilling to budge, you can make the problem worse by filing a claim with small claims court. In small claims court, individuals can sue a person or business without a lawyer (this may vary from state to state). According to Allen, in some states like Texas, you can sue for up to $ 20,000. While you may be charged for filing a case, the fees are likely low ($ 30 to $ 40) compared to your medical bill.

“And when you file this case, it really upsets the balance of power,” says Allen. “Now [the hospital] must go to a judge … to justify their unfair or inaccurate prices. And they don’t want to do that. “

Disputing a medical bill can be time consuming and frustrating, but Allen points out that depending on the cost of the bill, it could be worth it for you.

3. Pay your bill

When it comes to paying your medical bill, you shouldn’t choose to use a credit card unless you are sure you can pay your balance in full and on time. Using a credit card to change your balance from month to month could charge you a lot more interest.

First, learn about the financial aid policies of a hospital or doctor. Some hospitals offer discounts if you meet certain income conditions. If you don’t get a discount, some hospitals may also offer you a payment plan to pay over time, usually without interest.

If you must use a credit card to pay your medical bills consider using an introductory 0% APR credit card, which can give you a 0% interest rate until the first 21 months of card membership.

Two well considered options are Citi Simplicity® Card which has a 0% introductory period of 12 months on new purchases (then, 14.74% to 24.74% variable) or the Wells Fargo Reflect Carte Map which offers an introductory 0% APR on qualifying purchases and balance transfers for the first 18 months after opening the account; with an extension of up to three months (totaling up to 21 months) with minimum on-time payments during the introductory and extension periods (then, 12.99% to 24.99% variable.) introductions for the Reflect card are $ 5 or 3% the amount of each balance transfer, whichever is greater, for 120 days from the opening of the account. After that, up to 5% for each balance transfer, with a minimum of $ 5. (See rates and fees.)

Another option to explore is a medical credit card like the CareCredit® Credit Card or the Wells Fargo Health Advantage, which tend to act a bit like zero rate cards: they usually have an interest-free promotional period before rates are increased by 15-20%.

If you want a financing option that allows you to make monthly payments, there are also “buy now, pay later” options for health care expenses. Opy is a BNPL service specifically designed for healthcare, education, and auto maintenance and repair. Before signing up, you’ll want to check with your doctor’s office or hospital to make sure Opy is available for you.

Opy charges borrowers a fixed interest rate of 9.99% (or less depending on the merchant), and payment plans can last for up to 24 months. Notably, Opy has an interest rate lower than the rate offered on most credit cards. Unfortunately, you could end up paying a lot of interest depending on the amount of medical debt you owe.

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CareCredit and Wells Fargo Health Advantage credit card information was independently collected by Select and was not reviewed or provided by the card issuer prior to posting.

Editorial note: Any opinions, analysis, criticism or recommendations expressed in this article are the sole responsibility of the editorial staff of Select and have not been reviewed, endorsed or otherwise approved by any third party.


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