How to negotiate a hospital bill: a step by step plan
A practical plan to lower a hospital bill: get the itemized bill, check each line, compare with Medicare prices, then ask in writing.
Check my bill freeDo not pay the first bill right away
The first statement is often a summary. Paying it closes the discussion before you know what you are paying for. Call the billing office, say you are reviewing the bill, and ask them to hold the account so it does not go to collections while you review it.
Ask for the fully itemized bill
Ask for every line with its date, CPT or HCPCS code, revenue code, quantity and price. Without codes, nobody can check a bill. Ask for the financial assistance policy at the same time.
BillCheck writes this request for you, free.
Check each line
Look for the same service billed twice on the same day, a test billed on top of the panel that already includes it, more than one "initial" injection for one visit, charges dated outside your stay, and everyday items billed on their own. Not every repeat is an error: a second sample or the other side can be real, so ask for the reason.
Our guide to hospital bill errors explains each case.
Compare the prices
Medicare publishes what it pays for each code. A hospital is not required to accept that amount, but it is a fair reference. On real bills patients have shared, blood tests billed around $500 to $1,000 had a Medicare average under $10.
Ask in writing
Send a short letter: list the lines you question, the Medicare amount for each, and ask for the lowest amount they will accept, including any discount for paying in full. Keep a copy and note the name of every person you speak with.
Ask about financial assistance and the self-pay rate
Nonprofit hospitals must have a written financial assistance policy. If you have no insurance, ask for the self-pay price. If your bill is at least $400 above the good faith estimate you received before care, you can start a federal dispute within 120 days of the first bill.
Get it in writing before you pay
When the hospital agrees to a lower amount, ask for the agreement in writing, then pay.
More guides
- How to get an itemized hospital bill (free request letter)
- Hospital bill errors: what to look for on each line
- ER bill without insurance: what to ask for
- Out-of-network ER bill: your protection under the No Surprises Act
- Prices by service