Do you lose sleep worrying about medical bills that are bigger than your budget? You’re not alone. In 2020, nearly four million adults ages 65 and older reported having unpaid medical bills, according to a report from the Consumer Financial Protection Bureau. Of those people, 98% had health insurance but still had big bills. 

Big medical bills are a big headache for many Americans. But there are ways to manage over-the-top bills. One is to ask the doctor or medical facility to reduce the amount that you owe. 

“Consumers may not realize that you can contact the health-care provider or the hospital and ask to negotiate,” Jenifer Bosco, staff attorney at the National Consumer Law Center, told CNBC. 

Getting started

It pays to do some homework first. Follow these steps before you try to negotiate a lower bill: 

Put the bill on pause

It might take a while to resolve your issue. So ask the billing department to put the claim on hold temporarily. This will buy some time and help keep the bill from being turned over to a collection agency. 

Ask for an itemized bill from the provider

Look over the bill for errors. You might have a charge that belongs to someone else. There may  be mistaken charges for services you never received. Or you might have been charged twice for the same thing. Mistakes happen – and there’s actually evidence that they happen more for older people who are on Medicare or have multiple sources of insurance. If you spot something that doesn’t look right, ask about it.

Get familiar with medical codes

Every health condition has its own medical code. Mis-coding is sometimes the reason a service isn’t covered. For instance, changing a single digit means the difference between charging a patient for a colonoscopy versus a psychiatric exam.

Compare your bill with your explanation of benefits (EOB)

If the numbers on the bill and the EOB you get from your insurer don’t match up, talk to both your provider and the insurance company. Any differences between the bill and the EOB should be explained or corrected.

File an appeal

Insurance companies are required to justify how they decide a claim. If you believe something should be covered that they aren’t covering, you can appeal the decision. 

Keep in mind that there may be a limit on the number of times you can use the formal appeal process. Don’t waste an appeal on an issue that a simple phone call might fix. Try the call first. 

Get a patient advocate

If you hit a roadblock, consider reaching out to a patient advocate or navigator. They have specialized information and may be able to sort out an issue that you can’t. You can find one from The Patient Advocate Foundation. 

Don’t charge a contested bill on your credit card

Don’t pay your medical bill with your credit card while you’re appealing the bill.  If you do, you might not be able to negotiate. 

Keep in mind that interest rates are usually much higher on a credit card than what you may pay if you negotiate a payment plan with your health provider. You may even be able to negotiate an interest-free payment plan! 

Try these steps to avoid surprise health bills! 

Exploring other payment sources

If you are left with a large medical bill, look into other ways to pay it. For example, nonprofit hospitals are required to give financial assistance to patients with low incomes. Ask the hospital whether you qualify for this help. You may be eligible to have part or all of the bill canceled. To do so, you will probably have to provide a budget, list of assets, information about family members, tax returns, or proof of income. 

Don’t wait too long to apply for assistance. Some programs only give you about 240 days after receiving the care to ask for help. 

A social worker or financial counselor at a hospital can also help you find out if you qualify for services such as Medicaid, and will even help you apply. In some states, Medicaid will even pay toward bills you got before you were covered. 

Let’s make a deal

If you’ve looked into payment options and still have a big bill left, it’s time to negotiate. Contact the billing department, not your doctor, hospital, or other provider. The people at the billing department are used to negotiating fees. 

Follow these steps to lower your costs: 

• Politely state that you can’t afford the bill, and then ask for it to be reduced. 
• If you’re uninsured, you may have been charged the maximum amount that can be charged for a service. This is called the “master charge.” Ask for the Medicare rate instead. It’s usually much lower. You can also ask for a self-pay or cash discount. 
• Ask for a payment plan with the lowest interest rate possible. Be honest with the business department about what you can afford so you’re sure you can make the payments. Your rent or mortgage, utilities, and car loans should come before paying medical bills. 
• When you’ve reached an agreement with the billing department, get it in writing. Make sure there won’t be any changes to the interest rate or late fees on the original bill as long as you make your payments on time. 
• If the billing department doesn’t help, that’s the time to follow up with the hospital or provider and ask them to lower the bill. Even a little reduction in your bill can make a difference! 

Additional resources

• Consumer Financial Protection Bureau:  How to Read Your Medical Bill 
• Consumer Financial Protection Bureau: Medical Billing and Collections Among Older Americans 
• CNBC: Yes, You Can Negotiate Your Medical Bills 
• Centers for Medicare and Medicaid: How to check your bill for errors