How to negotiate hospital bills

Medical bills can blow up anyone’s budget. A survey by the Commonwealth Fund found that 64 million people had difficulty paying their medical bills. In fact, medical debt was found to be the single biggest cause of consumer bankruptcy in the U.S., according to several studies.

The cost of medical care can be daunting. A visit to the emergency room can set patients back by up to $700, according to estimates from Blue Cross Blue Shield of Massachusetts. Charges for a single surgical procedure can run thousands of dollars. For pregnant women, labor and delivery at a hospital can cost as much as $10,000 or more.

Those prices, however, aren’t set in stone. “Most people don’t know that you can negotiate your medical bills,” said Jeff Rice, M.D., CEO of Healthcare Bluebook, a health care pricing resource for consumers and employers. “And they don’t understand the huge difference between the list price and what providers accept as a discounted amount from the insurance company.”

He said that providers often accept 50 percent to 80 percent less than the amount billed. Here’s how to talk your way into substantially reducing your hospital bill.

Find Out the Fair Price
Chances are that you comparison shop before making most major purchases. When it comes to your medical care, you should do the same. “It’s much harder to negotiate a bill down than to go to a provider who offers a fair price to begin with,” Rice said. Fortunately, there are several resources to help you find the fair price for the procedure or treatment you need.

If you’re insured, you can start by checking with your insurer to see if it offers a cost comparison tool for providers in your network. You also can visit free resources such as or to find the cost for certain medical procedures in your area. You also can search online for “Medicare fee schedule” along with your state to get an idea of reasonable charges for treatment where you live, said Adria Goldman Gross, owner of MedWise Insurance Advocacy, which helps consumers resolve medical and insurance claims.

This information can help you identify the provider in your network with the best price for the procedure you need. Or you can use this information to negotiate a lower price with the provider of your choice.

Negotiate Upfront
Your best bet for getting a provider to lower the fee for medical care is to negotiate before you receive treatment. Always ask upfront what the procedure codes and charges are. Some providers even have an option in their phone menu to get pricing information, Rice said.

If the provider is charging more than the fair price in your area, ask the billing department to come down in price to match the lower rates offered by other providers, Gross said. If the provider won’t budge and the rate is significantly higher than what others charge, you might be better off going to another provider, Rice said. He pointed out that some providers charge less than others even when they work together in the same practice.

Offer to Pay Cash
In some cases, patients who are willing to pay cash can get an even better price than what insurance companies get, Rice said. So ask about the rate for a patient paying with cash compared with insurance. It’s especially important for patients without insurance to ask for a self-pay discount. Otherwise, they’ll get charged the full sticker price, Rice said.

Self-pay discounts are more common at independent centers than at hospitals, Rice said. But it’s always wise to ask.

Negotiate in Person
If you didn’t negotiate a lower price before receiving medical treatment, there are still steps you can take. Reach out to your provider, not your insurance company. Your best bet is to speak with someone face-to-face because it might be harder to say no if he or she has to look you in the eye when saying it, Rice said.

Tell the person with whom you speak to that you want to pay your bill but are concerned about how high it is. Be polite but say that you expect to pay a fair price, Rice said. If you can’t strike a deal, ask to speak with a supervisor. “You have to climb up that ladder,” Gross said. “There’s a good chance you’ll find someone who has a heart.”

Be wary if a provider offers you a payment plan rather than a discount. “You don’t want to pay $50 a month forever on a $5,000 bill that should’ve been $500,” Rice said. It’s better to continue pushing for a discount than spreading out the payment on an inflated charge.”

Avoid Collections
The worst thing you can do is avoid paying your bills altogether. Gross said that providers will send unpaid bills to collection agencies. And having a debt in collections will lower your credit score.

Before it gets to that point, show your provider some kind of proof that you can’t afford to pay your bill, Gross said. By providing the tax returns of a low-income client, she was able to negotiate the client’s $16,000 bill down to zero. Most physicians, clinics and hospitals should be willing to work out a deal with you, she said.

If your bill does go to collections, most agencies will settle for a discount of 10 percent to 20 percent, Gross said. But start by offering to pay just 50 percent, then negotiate from there.

If you don’t have success negotiating your medical bills on your own, it can make sense to hire someone to help you, Rice said. Consultants charge by the hour or get a percentage of the amount that they help you save, which is typically 25 percent to 35 percent, Gross said.

Don’t let your medical bill become a financial bully. Find ways to reduce how much you owe. How to negotiate hospital bills

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