We’ve written about this in the past (7 Negotiating Tips to Help Lower Your Medical Bills) as well as dedicated an enormous part of our Ultimate Guide to it (Part 2: Negotiating Your Medical Bills) but this is a big enough topic that it bears revisiting.
Below are the 5 steps we recommend taking in order to negotiate your medical bills (however, use the links above for even more information)
- Determine what to pay
- See What Discounts are Offered
- Submit an Offer
- Hire a Medical Billing Advocate
Step 1: Determine What to Pay
Before doing anything, you need to start by determining what you want your offer to be. There are two factors to consider when looking at this: what a fair price for these services might be and what you can actually afford to pay.
We’ve said it before and we’ll say it again – the hospital chargemaster rate (or the rack rate that you’re getting charged for your medical procedures) has absolutely no bearing on reality. The average chargemaster rate is over 4x the hospitals costs, and we regularly see chargemaster rates 10x or even 20x a hospital’s costs.
At Resolve, we’ve built an algorithm to run a ‘Fair Price Analysis’ to determine what a hospital bill should be. Our algorithm takes into account what it cost the hospital, what insurance pays on average, and what medicare pays on average. However, you can do detective work at home to come up with your own price. The first step is to get the itemized bill – a bill that lists each procedure individually. Then take that bill and use healthcarebluebook.com to look up what the ‘market rate’ for those procedures are.
The second step is to look at your own finances and determine what you can pay. It doesn’t help to come up with a ‘fair price’ if you can’t pay it.
Step 2: See What Discounts are Offered
Once you’ve determined what you can pay, call the billing office and see what discounts might be offered on your medical bills. There are times when you might be able to get a prompt-pay, self-pay, or lump-sum discount.
While quite often, the hospital will refuse to provide a discount, it doesn’t hurt to ask!
Step 3: Submit an Offer
If the hospital is unwilling to provide any discounts off the top – we recommend submitting an offer letter detailing the situation, what you’re willing to pay, why you believe that is a fair offer, and that if agreed upon you’re prepared to make payment immediately.
The best way to do this is via fax. That way the offer is in writing and you have the opportunity to elevate the situation past the people who work the phones (who almost never have the authority to provide large discounts).
Call the main number and ask for a fax number to submit the settlement offer to. Then write up a letter detailing the above and send it via fax. Be prepared to follow up regularly, as hospitals can take a long time to process any paperwork – and one of their favorite tricks is to “lose” the fax.
Step 4: Escalate
If you still don’t get the answer you want, be prepared to escalate the situation. Call and ask to talk to a manager. Or do a little LinkedIn research and find people at the hospital with titles like DIrector of Revenue Cycle Management, Director of Finance, Director of Patient Billing and request to talk to them directly.
One trick that we like to use is to use sales tools like hunter.io to find the work email address of people who might be able to make a settlement offer – and then reach out to those individuals directly with a settlement offer. Even if they don’t have the authority to make a decision, they can often point you in the right direction.
Step 5: Hire a Medical Billing Advocate
If all else fails, you can hire an expert to help you fight your medical bills. A good expert will know how to find the right person at the hospital and make the right argument to get your bills lowered.
Here at resolve, our negotiators use our fair pricing algorithm and our structured process to cut through the bureaucratic red tape and get you discounts on your medical bills. We’ve perfected the art of finding the right person and presenting them with the right argument.
If you’d prefer to look around, both Greater National Advocates and The Alliance of Professional Health Advocates have directories of advocates that you can talk to to find the right person to fight your medical bills.
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.