I got a $4,200 bill for what I thought was a routine outpatient procedure. I called the billing department, asked a few specific questions, and ended up paying $1,600. That is not unusual. Medical billing in the US is one of the most negotiable transactions you will ever encounter, and almost nobody negotiates. The hospitals know this. Insurance companies know this. The only person who doesn't seem to know is the patient staring at a terrifying number on a piece of paper.
First things first: request an itemized bill. Not the summary statement they send you by default -- the full itemized breakdown showing every single charge. CPT codes, quantities, unit prices. You would be amazed what shows up. I have seen people charged for two MRIs when they only had one. Duplicate charges for the same blood draw. Charges for supplies that were never used. A friend of mine found a $780 charge for 'surgical tray' on a bill for an appointment where no surgery happened. About 80% of medical bills contain at least one error. Eighty percent.
Once you have the itemized bill, compare prices using the Healthcare Bluebook (healthcarebluebook.com) or Medicare's fee schedule. Hospitals routinely charge 200-400% above what Medicare pays for the same procedure. You are not going to get Medicare rates, but knowing the fair market price gives you leverage. If the hospital charged $3,000 for something Medicare pays $800 for, you have real room to negotiate. Even getting to 150% of Medicare rates would save you a significant amount.
Call the billing department and be polite but direct. The script I recommend: 'I received my itemized bill and I'd like to discuss a few charges. I also want to ask about any financial assistance programs or prompt-pay discounts you offer.' That last part is important. Almost every hospital has a financial assistance (charity care) program. Nonprofit hospitals are legally required to under the ACA. Many for-profit hospitals have them too. Income limits are often surprisingly generous -- some programs cover families earning up to 300-400% of the federal poverty level.
The prompt-pay discount is the easiest win. Many hospitals will knock 10-30% off your bill if you pay the negotiated amount in full within 30 days. Some go higher. I have seen 40% prompt-pay discounts at smaller regional hospitals. If you cannot pay in full, ask for a zero-interest payment plan. Most hospitals will set one up, and by law they cannot charge interest on payment plans in many states. Get everything in writing before you send any money.
If you are uninsured, you actually have more leverage than you think. The No Surprises Act requires hospitals to give uninsured patients a good faith estimate before treatment. After treatment, many hospitals will offer uninsured patients a self-pay rate that is significantly lower than what they bill insurance companies. I worked with a woman in Georgia who was billed $22,000 for a two-night hospital stay. She was uninsured. After requesting the self-pay rate and applying for financial assistance, her final bill was $3,400. These programs exist. You just have to ask.
If the hospital will not negotiate directly, consider hiring a medical billing advocate. They typically charge 25-35% of the amount they save you, so they are only worth it for larger bills -- think $5,000 and up. For smaller bills, a patient advocacy nonprofit like the Patient Advocate Foundation (patientadvocate.org) offers free help. Also worth knowing: medical debt under $500 no longer appears on credit reports as of 2023, and the three major credit bureaus removed all paid medical collections. The landscape has shifted in your favor. Use it.
