If you receive an unexpectedly high medical bill, the following steps may help you waive or lower the price:

  1. Request an itemized bill, and dispute any errors in writing:

    Ask the provider or hospital for a copy of your medical records and an itemized bill with specific billing, item, procedure, and diagnosis codes. Reports show up to 80% of medical bills contain an error, duplicates, or incorrect charges. If your bill has discrepancies, immediately dispute them. 

  2. Research the actual price in the hospital’s pricing file, compare it to your bill, and dispute any discrepancies in writing:

    By law, hospitals are required to post their prices on their website for all items and services they provide, across all payers and plans, including the discounted cash prices. PatientRightsAdvocate.org has created the Hospital Price Files Finder tool to help identify hospital pricing files. Click on your state and search for your hospital’s pricing file by name, city, or zip code. Once located, search for each item by the code on your itemized bill. Then search for your insurance payer and plan, or the discounted cash price, and compare those prices to the price you were charged. If you find overcharges, call your hospital or write to the CEO and CFO.

  3. See if you qualify for financial assistance from the hospital:

    Hospitals provide free or discounted care to patients who are financially eligible or who qualify for a hardship discount. Read the hospital’s charity care policy and reach out to the billing department to see if you qualify. Organizations like Dollar For have used these policies to erase more than $39 million in medical debt.

  4. Ask to see the contract:

    If the hospital, provider, or a debt collector insists on payment for an unfair bill, demand they provide you with the signed contractual agreement that obligates you to pay. With no written, signed agreement, you have no legal obligation to pay.

  5. Address out-of-network services and refuse to pay for inappropriate care:

    Many patients are unaware that they can receive an out-of-network charge at an in-network hospital, resulting in nearly 60% of Americans receiving an unexpected bill. If you received unnecessary care, were charged for out-of-network services, or experienced an avoidable complication, call or write your hospital or provider and demand that you not be charged for these services.

  6. Research the fair market price and use that to negotiate:

    Look up what Medicare and commercial insurance companies pay for the service that you need. Healthcare price checking platforms such as Turquoise Health, Healthcare Bluebook, MDsave, and Clear Health Costs are also available to help patients find the best price. For surgical procedures, you can also compare your charges with the transparent prices at The Surgery Center of Oklahoma and Texas Free Market Surgery.  You can then use those, as well as discounted cash prices, to negotiate. Discounted cash prices are often up to 40% less than insurer negotiated rates.

  7. Call your insurance company:

    If you have insurance, check your explanation of benefits (EOB) to determine if the service or procedure is covered. Call your insurer’s customer service line if your health plan isn’t covering something you thought would be covered.  If the bill should be covered and the insurance company is refusing to pay, contact the National Association of Insurance Commissioners. You can also contact your state  and file an appeal.  

  8. Call your employer’s human resources department:

    If you have health insurance through your employer, you can ask your human resources department to advocate on your behalf.

  9. Call or write your hospital’s leadership:

    If none of the steps above resolves your medical billing issue and you believe you have been unfairly overcharged for services, write to the hospital’s CEO and CFO. You can also contact hospital board members through their offsite office and inform them of the hospital’s predatory billing practices.

  10. Work with organizations that have a proven record of disputing medical bills.

    Visit these websites and tell them Power to the Patients sent you.

    · PatientFairness.com offers information, strategies and tools for patients to fight problem medical bills.

    · DollarFor.org helps patients apply for hospital charity care and also helps hold hospitals accountable to federal financial assistance laws.

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