Medical Bill Too High? How to Lower It Before You Pay

The bill arrives.

Maybe it’s $800. Maybe it’s $8,000. Maybe it’s a number so absurd you briefly wonder whether you accidentally bought the MRI machine.

Before you panic, put it on a credit card, empty your savings account, or assume you have no choice but to pay whatever number appears at the bottom of the page:

Stop.

A medical bill is not always the final amount you owe.

Billing errors happen. Insurance claims get processed incorrectly. Discounts and financial assistance programs exist. Payment plans may be available. And sometimes the bill you received doesn’t contain nearly enough information to determine whether the amount is correct.

Your first job isn’t to pay it.

Your first job is to understand it.

Don’t pay a medical bill you don’t understand

A statement from a hospital, doctor’s office, laboratory, imaging center, or other healthcare provider may show an amount due without clearly explaining how they arrived at that number.

Before paying, compare the bill with your insurance company’s Explanation of Benefits, usually called an EOB.

The EOB is not a bill.

It shows how your insurer processed the claim, including what the provider charged, what the insurer allowed, what insurance paid, and what the insurer says may be your responsibility.

Compare that patient-responsibility amount with the bill you received.

If they don’t match, find out why.

1. Ask for an itemized bill

If all you received was a summary statement, contact the provider’s billing department and request an itemized bill.

You want to see what you were actually charged for.

Review it carefully.

Look for things that don’t make sense:

• Services you don’t remember receiving

• Duplicate charges

• Medications you didn’t receive

• Tests that weren’t performed

• Incorrect dates

• Charges from providers you don’t recognize

• Quantities that appear wrong

• Procedures that don’t match what happened

You do not need to become a medical billing expert.

You’re looking for discrepancies.

If something looks wrong, ask about it.

2. Compare the bill with your Explanation of Benefits

Log into your insurance account or contact your insurer and locate the EOB for the claim.

Check:

Was the claim processed?

Was anything denied?

Was the provider considered in network?

What amount did the insurer allow?

What did insurance pay?

What amount does the EOB say you may owe?

If insurance denied all or part of the claim, don’t automatically assume the provider’s bill is correct.

Find out why the claim was denied.

The problem could involve coverage, medical necessity, prior authorization, coding, missing information, or another issue that may need to be corrected or appealed.

If your health insurer denied the care or claim, see Health Insurance Denied Your Care? Here’s How to Appeal in the Patient Survival Guide.

If the problem involves prior authorization, see Prior Authorization Denied? What to Do Next.

3. Call the billing department

Once you understand the bill, call the provider.

Don’t just ask:

“Why is this so expensive?”

Ask specific questions.

Can you explain these charges?

Has insurance finished processing the claim?

Were any charges denied by insurance?

Is anything being resubmitted or corrected?

Are there discounts available?

Do you offer financial assistance?

Is there a lower amount available if I pay directly or promptly?

Do you offer an interest-free payment plan?

Write down the name of the person you spoke with, the date, and what they told you.

If they agree to change the bill, ask for the new amount in writing.

4. Ask about financial assistance

This is one of the most important questions you can ask:

“Do you have a financial assistance program?”

Hospitals and health systems may have programs that reduce or forgive bills for patients who qualify.

Eligibility rules vary.

Don’t assume you earn too much.

Don’t assume financial assistance is only for people without insurance.

Don’t assume the person who mailed you the bill has already checked whether you qualify.

Ask.

If a program exists, request the eligibility requirements and application.

You may be asked for documents such as tax returns, pay stubs, proof of household income, or other financial information.

5. Ask whether the bill can be reduced

If the bill is accurate but unaffordable, ask whether the provider can reduce it.

There is nothing inappropriate about asking.

You can say:

“I can’t afford this balance. Are there any discounts or reductions available?”

You can also ask whether the provider offers a discount for paying a negotiated amount at once.

If you are uninsured or received care outside your insurance coverage, ask whether there is a self-pay or cash-pay rate.

A provider saying you owe $4,000 does not mean there is no circumstance under which the provider will accept less.

Ask before assuming.

6. Be careful about putting medical debt on a credit card

A giant medical bill creates pressure to make it disappear.

Moving the balance onto a regular credit card may make the hospital statement disappear, but it doesn’t make the debt disappear.

Now you may have credit card debt, potentially with significant interest attached.

Before using a credit card, ask the provider about:

• Financial assistance

• Discounts

• Reduced settlements

• Interest-free payment plans

• Other hardship options

Understand the terms of any financing arrangement before agreeing to it.

The fastest way to make a bill go away is not necessarily the cheapest way to resolve it.

7. If the bill involves out-of-network or surprise charges, investigate before paying

Some medical bills involve protections under federal or state law.

The federal No Surprises Act provides protections against certain unexpected out-of-network bills, including many situations involving emergency care and out-of-network clinicians working at in-network facilities.

The rules are specific, and not every unexpected medical bill qualifies.

But if you went to an in-network hospital and suddenly received a large bill from an out-of-network anesthesiologist, radiologist, emergency physician, or other clinician you didn’t knowingly choose, don’t automatically pay it.

Find out whether surprise-billing protections apply.

8. Don’t ignore the bill

Questioning a bill is different from pretending it doesn’t exist.

Pay attention to notices and deadlines.

If you are disputing the bill, applying for financial assistance, waiting for insurance to reprocess a claim, or appealing an insurance decision, tell the provider’s billing department.

Ask whether the account can be placed on hold while the issue is being reviewed.

Get confirmation when possible.

Keep copies of everything.

9. Keep a paper trail

Create a folder for the bill.

Save:

• The original bill

• The itemized bill

• Explanation of Benefits

• Insurance correspondence

• Financial assistance applications

• Appeal documents

• Emails and portal messages

• Receipts

• Names of people you speak with

• Dates and times of phone calls

• Confirmation and reference numbers

If somebody promises to adjust the balance, document it.

If somebody tells you insurance is reprocessing the claim, document it.

If somebody says your account won’t be sent to collections while an appeal is pending, ask for that in writing if possible.

Memory is not a billing system.

10. Get outside help if you’re stuck

You do not have to understand every corner of medical billing law to question a bill.

Depending on the problem, help may be available from your state insurance department, state attorney general, federal agencies, nonprofit patient organizations, legal aid organizations, or patient advocates.

For certain surprise medical bills, the federal government also operates a No Surprises Help Desk and complaint process.

If you’re insured through an employer, your benefits or human resources department may also be able to help determine why a claim was processed the way it was.

The right place to seek help depends on what kind of insurance you have and what went wrong.

Before you pay, ask questions

Medical bills arrive dressed like facts.

They have account numbers. Due dates. Official logos. Very serious fonts.

That doesn’t mean you should blindly pay whatever number is printed on them.

Make sure the bill is accurate.

Make sure insurance processed the claim correctly.

Ask for an itemized statement.

Ask about financial assistance.

Ask about discounts.

Ask about payment plans.

Investigate surprise charges.

Document everything.

And if something doesn’t make sense, keep asking until it does.

The number at the bottom of a medical bill is where the conversation starts, not necessarily where it ends.