If your medical bill just provides a summary of the charges, call the billing department and get a detailed statement – you’re entitled to it. You may want to make several copies of the bill before you start reviewing it.
Begin by reading the bill carefully and circling any charges that you don’t understand.
Do the services/procedures listed on the bill accurately reflect the care you received?
Are there any duplicate charges?
Do the dates listed on the bill match the days you received care?
Are any procedures that were rescheduled or cancelled still listed on your bill?
If you or your insurance company pre-paid part of the bill, is that amount listed on the bill?
Medical bills use specific coding systems to provide specific information about the treatments and services patients receive. Understanding how these codes work are the best way to spot costly errors.
CPT Codes (Current Procedural Terminology): Insurance companies use these five-digit numerical codes to determine what they will pay to your provider – and what you owe. CPT codes are listed next to the items in a bill’s description of services. If a charge seems incorrect, you can look up the meaning of CDC codes.
HCPC Codes (Healthcare Common Procedure Coding) is used by Medicare. Level 1 HCPC codes are identical to the CPT codes. Level II are used by healthcare service providers and medical equipment suppliers.
ICD Codes (The International Classification of Diseases) describe patient symptoms and the medical procedures used to address the problem. ICD codes can be reviewed online.
A word of warning: medical coding is complex, and like any complicated system is prone to human error. A simple one-decimal typo can significantly raise the cost of a medical bill, and if you’re not familiar with medical coding these errors can be very difficult to spot. If your bill is a multi-page monster with a terrifying total – or if you simply don’t have the time, energy or inclination to deal with the process - consider working with a medical bill negotiation service rather than trying to find errors and manage bill reduction discussions on your own.
Determining your desired result is critical in any type of negotiation. Too often though, people approach medical bill negotiation with nothing more than a vague hope of getting the bill reduced. Instead, use the “fair and reasonable” rates for medical procedures to negotiate your bills. You can find these rates on websites such as FAIR health or Healthcare Bluebook. If the rate you’re being billed is out of line with the fair and reasonable rate data, you have good starting point for your negotiations. You should also have a clear idea of what you can pay, and the total reduction you’re seeking, before you begin negotiating.
Obviously, if you found errors on your bill, call the billing department or your healthcare provider and ask to have the mistake/s corrected. After you’ve addressed the errors and know the new total, you can ask for a reduction on that bill, based on your ability to pay.
Even if there are no significant errors or discrepancies on your bill, ask for a discount anyway. Speak to someone from the billing department, explain your situation, particularly if you’re uninsured/under-insured and paying out of pocket, have just been laid off, or have another significant issue in your life that makes it difficult or impossible to pay the entire bill. Or you can simply tell the healthcare provider “There is no way that I can pay this bill. I need to reduce the cost, and work out a payment plan.”
Hospitals or medical facilities will typically offer a 10%-20% discount as an opening gambit. Check the fair health rates to see if that discount aligns with the reported average and negotiated rates. If not, continue to negotiate. Even if the reduced cost seems right, you may want to push for a lower rate anyway. Billing departments would rather work with you than have you walk away from the bill entirely.
Generally, you will have a maximum of two years from the original billing date to pay off your bill. It is important to get an interest-free payment plan for the discounted amount. Offering a cash payment up front (10%-15% or so is good, if you can afford it) can help smooth the way to a reasonable payment plan. Make sure the payment amount is something that you are likely to be able to live with, don’t lock yourself into an impossible situation just to get a faster discount.
After you’ve made payments on time for a year or so, you may be able to try renegotiating your deal. You should have a reason for requesting the bill be forgiven or further discounted; continued bad health, unemployment, moving expenses, big changes in your life (pregnancy, adopting a child, spousal illness), etc.
Contact the billing department, tell them you’ve been paying monthly for (however long you have) and ask if the bill can be reduced or forgiven due to whatever your current life situation is.
Keep a record of every person you speak with, their title and contact information, the date and time you spoke to them, and notes on what each of you said throughout the entire process. When you’re offered a discount or payment, get it in writing before you make a payment. Keep your notes and documentation at least until you’ve received notice that the bill has been paid in full.
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