You can negotiate your cable bill. You can negotiate your rent and the sale price of your home or vehicle. But did you know you can negotiate your medical bills, too?
Depending on your situation, you may be able to get some or all of your medical expenses written off if you know the rules of the game.
Note that all references to legal protections are applicable under federal law. Your state may offer further consumer protection under state legislation.
Negotiating Medical Bills
You can’t negotiate all of your medical bills, but you can certainly negotiate some of them. You’re not likely to be able to negotiate insurance copays and deductibles–especially if your provider is in-network.
Taking this action may violate their agreement with your insurer. However, they may be willing to lower your overall bill, which could potentially affect your copays and deductibles, depending on if your insurance contract calculates these numbers in percentages or real dollars.
Negotiating Medical Bills with Out-Of-Network Service Providers
Believe it or not, out-of-network service providers may be more likely to negotiate with you after your insurer has issued your Explanation of Benefits (EOB) and issued the provider their final payment. (This doesn’t mean you should skip trying to get your insurer to cover the expense as an in-network event.)
When you negotiate after insurance has submitted payment and issued an EOB, the medical provider has already gotten all the money they’re going to get out of the insurance company.
While emergency care is very often supposed to be covered as in-network by insurance companies per the legislation that is the Affordable Care Act (also known as the ACA or Obamacare,) very often insurers will put up a fight before acknowledging the legitimacy of your emergency.
You’ll often be forced to call the service provider and request that they change the coding to indicate that your visit was, indeed, emergency care. Then you have to wait for them to resubmit the claim with your insurer.
More waiting is in store until your insurer issues you a new EOB, which may or may not actually reveal a fix to the in-network/out-of-network problem.
Even if your claim is acknowledged as an emergency as covered under the ACA, your insurer may not accept the charges as “reasonable.” They can then pay whatever they have listed as a reasonable market price for the services you received.
That means they only paid the provider part of balance, and the rest falls on your shoulders.
Which is the second reason out-of-network service providers will sometimes negotiate with you: If they know they’re going to have to wait years to get $4,000 out of you through a zero-percent-interest payment plan, they may be more willing to reduce your bill in exchange for an immediate lump-sum payment, or even in exchange for a zero-percent-interest payment plan with a shorter repayment term.
Negotiating Medical Bills as an Uninsured Patient
If you do not have health insurance, it’s always worth it to negotiate your bill. Typically, it’s best practice to do this before you go in for a procedure or exam, but it’s completely possible to negotiate after the fact, too.
If you are not insured, the medical provider must grant you Medicaid/Medicare pricing. If they do not, they are engaging in discriminatory pricing. While there are some technical caveats, overall this is overwhelmingly good news for those who may live in one of the 13 states who are still without Medicaid expansion.
Financial Assistance Programs
Under the ACA, all nonprofit medical providers must offer a financial assistance program to patients. You can qualify for these programs whether or not you have a health insurance policy; qualifications are income-based.
If you qualify for the financial assistance program, you qualify for protection against discriminatory pricing as we discussed in the previous section, as well as a full- or partial-forgiveness of your medical debt.
Ask for an explanation of each line item.
Billing errors are rampant in our day and age. It is important that you review every single bill and EOB you receive so that you’re aware of exactly what you’re being charged for.
You may be getting billed twice for something. You may be denied coverage for a service which the ACA mandates health insurers must cover. Or you may be getting billed for the wrong service altogether or a procedure you never received.
By reviewing your bills and EOBs, you can ensure that you’re being billed accurately, and check that your health insurer is complying with ACA standards.
If you find yourself in the negative version of either of these scenarios, confront your insurer or the medical provider’s billing department head on and immediately. Knowing your rights and checking medical coding for accuracy can save you a ton of money—even if it’s not negotiating, per se.
You can’t negotiate a balance you don’t legally owe. But you can call out those who have tried to charge you illegally in a professional manner.
Review Your Covered Benefits
Of course, in order to demand respect for your legal and contractual rights, you have to know what they are. The first place you should start your research is your health insurance policy.
While pouring through a policy can seem incredibly boring, it’s a tactic that can save you a lot of money as you make an argument that lack of coverage violates your contract.
This process is made easier in the modern day and age by digital copies of insurance policies being made available online via PDF. When you search your policy this way, you should be able to Ctrl+F your way to the part of the policy that either explicitly includes or excludes the medical costs you need the insurance company to cover.
If it is not explicitly listed as a covered or uncovered expense, you can have your doctor write a note of medical necessity along with a prescription for the item. While this tactic isn’t always successful—especially on the first attempt—having your doctor on your side as you go to bat against the insurance company can be incredibly advantageous.
Educate Yourself on Health Insurance Law
The second thing you’d be wise to do as you review your bills and EOBs line by line? Research health insurance and billing laws. A great place to start your research if you have an ACA plan is researching mandated essential coverages.
It’s also a good idea to review state laws. For example, many states require employer plans which are not issued via self-insurance (as they are at many large corporations) provide full coverage for Autistic individuals and the services which their neurodiversity requires.
If you don’t call an insurance company out on this, they’re unlikely to come back to you with an apologetic refund check when/if they catch the mistake themselves.
If you find yourself in a situation where you need legal help due to medical debt but cannot afford counsel, be sure to locate someone who can help you via Legal Aid—especially if you suspect you are being filled unfairly.
Navigating the world of health insurance is tough.
Not only is navigating the world of health insurance tough; it’s confusing. It’s frustrating. And it’s time consuming.
But by educating yourself on your legal rights and the legal obligations of insurers and medical care providers, you can do your best to make sure you’re not overpaying—and that you’re negotiating your medical bills where appropriate.