At Resolve we’ve seen hundreds of medical billing cases and successfully saved our patients enormous amounts of money by negotiating directly with the hospital to lower the amount that they charge.
While it may seem odd at first, it’s very possible that the number on your bill may be fully negotiable. In fact, the initial number hospitals charge averages over 4x their actual costs, and can be up to 10-15x their actual costs. If you haven’t received a discount on your bill (either from having health insurance or a ‘self-pay’ discount given to those without insurance), it may be worthwhile to try negotiating to see what can be done to lower the amount that you owe.
Below we’ve listed 7 techniques our negotiators use to maximize savings. These techniques are born out of negotiating strategies taught at the nation’s top Business and Law schools and improved by direct experience negotiating bills.
Tip #1: Find an Internal Advocate
The best thing that you can do is to find someone on the hospital’s side who’s willing to help. Not only can that person guide you through the process and help you figure out what you need to do (or even what to ask for), they can also go to bat for you internally to get things done.
However, this is far easier said than done. In many instances – the people manning the front lines of billing offices are both trained to side step questions and are not empowered enough to drive things forward. While there are exceptions to the above, usually the best way to search for an internal advocate is to explain your situation and then politely but firmly request to speak to a supervisor.
It’s also important to keep in mind that you need to get people to want to work with you. While dealing with extremely high medical can be very emotional – angry accusations, yelling, or even overt stubbornness can cause people on the other end of the line to dig in their heels and refuse to help you. The person on the other end of the line did not cause cause the issue nor set the prices that you’re dealing with. Expressing frustration (and even fear or sadness) at the situation is fine, just try to avoid expressing it at the individual specifically.
When describing your situation, it’s important to avoid accusatory language such as “you” and “your”. Instead talk about what happened and how much of an impact the bill has on you. If you get an answer that sounds crazy (for instance we’ve had hospitals suggest going on a payment plan for a $300,000 bill) – questions such as “how am I supposed to do that?” come off as accusatory. Instead restate your position, express fear that their proposed solution won’t work for you and ask for suggestions to help make it work or come up with an alternative path.
Finally – everyone wants to look good for their boss, and figuring out how to do this can help you win over an advocate, which leads us to our next suggestion….
Tip #2: Find a Win-Win Solution
Negotiations classes at top Business and Law schools don’t emphasize squeezing every last drop out of the person you’re negotiating about. Instead, they focus on identifying a Win-Win Solution – that is an agreement that benefits both parties.
Like finding an advocate, this is far easier said than done. We recommend working to figure out what the key metric that the person on the other end of the line is being measured on. That is, what do they care about? Whether it’s collecting a percentage of money upfront, lowering ‘outstanding balances’ on the books, or getting people on a payment plan – it’s important to understand what the person on the other end of the line is looking at when negotiating.
At Resolve we see situations where hospitals want to collect a certain percentage above their costs, lower total outstanding accounts receivable that’s over 12 months overdue, and a host of other metrics. Each situation requires its own thought process on how to best set things up and proceed.
Once you reach the right person (your internal advocate), you can directly ask up front what metric they’re most concerned about. Saying something along the lines of “I can’t afford to pay what’s currently being charged but I’d like to work out something that I can pay and satisfies hospital requirements – what metrics are you most concerned about so I can propose something that works for everyone?” can be very effective.
Then, it’s a matter of crafting a solution that works, whether its paying a lump sum up front in exchange for a significant discount or setting up a payment plan, or a host of other options.
Tip #3: Separate People From the Problem
While we’ve touched on this in previous tips, this can’t be emphasized enough. The person you’re talking to on the other end of the line may be able to solve your problem, but they certainly didn’t create it.
As mentioned above, try not to use accusatory language – avoid saying “you’re charging me” or “you guys are charging me”. Rather talk about how “these charges are more than I can afford”.
The idea here is to avoid putting people on the defensive, as we all want to dig in our heels when we feel like we’re being attacked.
Tip #4: Write Everything Down
While this may seem superfluous, we cannot stress enough how important it is to write everything down and get everything in writing.
To start, it’s good practice to have a document (either in a notebook or a Word document) where you record every interaction you have with the hospital. Include the date, the person on the other end of the line, and what was talked about. Also record any bills or notices you receive in the mail and any correspondence you send out.
Having the above not only allows you to track your work and organize everything, it also allows you to have more productive conversations with people on the other side of the phone. Politely pointing to multiple efforts to get things done can often ‘unstick’ situations that are not moving. Additionally – almost all hospitals and billing offices take notes – so they’ll know what was talked about on previous calls.
In addition to taking organized notes on your conversations, you should make a practice of sending all settlement offers via certified mail or fax. This way there’s a paper trail of everything. Hospitals are large bureaucracies and it’s not uncommon for things to get lost. Having a papertrail helps to mitigate these.
It’s also best to request any responses or offers from the hospital in writing as well. Nothing is worse than getting an offer for a major discount off your bill and then not having it recorded and the hospital refuse to honor that discount. Any time the hospitals offers you a discount, request that they send it via mail or fax to you.
Tip #5: Be Persistent
Don’t give up on the first. At Resolve, we often get told ‘no’ dozens of times before we finally get to an agreement that works for everyone.
If your initial proposal is denied, you can ask to speak to a supervisor. If you continue to get told no, thank them for their time, hang up, wait 3 days, and then try again. This kind of persistence does two things: 1) shows the hospital that you aren’t going away, and 2) gives you the opportunity to talk to more people, one of whom may end up becoming an advocate for you internally.
Polite persistence pays off, don’t give up!
Tip #6: Let It Wait
If you’re still not getting the answer you want even after multiple tries, let it wait for a few months and then call again. The hospital ‘revenue cycle’ (what they call the process flow that your bills move through before they get sent to collections) can be very complex and have different rules about allowable discounts at different stages.
Because the likelihood of actually collecting on a bill decreases significantly as bills get more and more past due, hospitals may be willing to provide discounts to bills after they’ve sat around for awhile.
You may even want to let the bill go to collections (even if a bill goes to collections it won’t immediately show up on your credit report – you have at least 6 months to get things settled). Collection agencies are often authorized to give a discount and are used to negotiating with consumers and professional negotiators.
Tip #7: Get Creative – Contact a Higher Up
If all else fails, you may want to send a settlement offer to the CEO or CFO of the hospital via certified mail. This can be difficult – as you need to get it directly to their office and not just the main billing office.
However, once you figure out the address, sending a signed letter via certified mail both forces the C-level executive to acknowledge receipt and improves the likelihood that they’ll look into it (or direct someone on their team to look into the situation). While we at Resolve have had success with this tactic, we recommend using it only as a last resort.
Our mission at Resolve is to make healthcare bills fair for everyone. We work with patients all day long to help them save tens or hundreds of thousands of dollars off their medical bills.
If you have a medical bill you’d like help with, check out our Guide to Lowering Your Medical Bills, give us a call at 8777-245-4244 or Schedule a Free Consultation to discuss your situation with one of our experts.
Braden founded Resolve after experiencing first hand how unfair the system is for patients. Prior to Resolve, he built and ran Operations for a renewable energy company and then built and ran Product, Growth, and Operations for a VC-funded edtech company. He received his MBA from Dartmouth’s Tuck School of Business and BA in Philosophy from the College of William and Mary. When not trying to lower healthcare costs he can be found outdoors mountain biking, skiing, or hiking with his dog.