How to negotiate a medical bill (even without insurance)

Can you really negotiate a medical bill?

Yes, you can negotiate a medical bill. A medical bill is not like a price tag in a store. The number on the first bill is often just where the conversation starts. Billing offices talk to people about their bills every day, and many have ways to lower a bill or spread it out over time.

You do not need insurance to ask. People without insurance often have more room to talk, because the office would rather get paid something than send the bill to collections. This guide gives you the steps in order, and the scripts are written so you can read them out loud. If you feel overwhelmed, start with our calmer overview of where to start with medical bills.

Step 1. Ask for an itemized bill

An itemized bill lists every charge, one line at a time, instead of one big total. Many first bills show only a summary. You cannot check what you are paying for until you see the details.

Here is a simple script for the phone.

• "Hello, my name is [your name], and I am calling about the account for [patient name], date of birth [date]."
• "Could you please send me a fully itemized bill, with the billing code and the price for each line?"
• "Could you also tell me whether this account is on hold while I review it?"
• "May I have your name and a direct number or extension, please?"

Ask them to hold the account while you review it. Write down the date, the person's name and what they said.

Step 2. Check the bill for errors

Billing mistakes happen more often than you might think. When your itemized bill arrives, read it slowly with a pen in your hand. You do not need to be an expert. You are only looking for things that do not match your visit.

• Look for charges for a test, medicine or service that you did not receive.
• Look for the same item listed two times.
• Check that the date is right and that the visit was really yours.
• Check that you were not charged for a longer or more complicated visit than the one you had.
• Look for services that were already included in another charge.

If something looks wrong, call the billing office and ask about that line by name. Stay calm and say something like, "I see this charge on line [number], and I do not think I received that service." Then ask them to review it. If you are not sure what a line means, ask them to explain it in plain words. You can also ask the doctor's office what was done at your visit.

Step 3. Ask about financial assistance first

Before you talk about discounts, ask if there is a financial assistance program, sometimes called charity care. This is free or reduced-price care for people with limited income. The IRS requires nonprofit hospitals to have a written financial assistance policy and to share it with the community they serve.

The IRS also says that once you are found eligible, the hospital may not charge you more than the amounts generally billed to insured patients. That means no more than what the hospital usually gets paid for the same care by insurance. This applies to emergency or medically necessary care.

Our guide on hospital financial assistance shows you how to apply. Do this before you agree to any payment plan, because assistance can lower the bill itself.

• "Does the hospital have a financial assistance or charity care program?"
• "Can you send me the application and a list of what proof of income you need?"
• "Can the account stay on hold while I apply for help?"

Step 4. Ask for the self-pay discount

If you have no insurance, or you are choosing not to use it, offices call you a self-pay patient. Many offices have a lower price for people who pay on their own. Some will also take less if you can pay promptly. Policies differ, so you have to ask. Our guide on how to ask for the cash price goes deeper.

• "I do not have insurance, so do you have a self-pay or uninsured discount?"
• "What would the bill be if I could pay it all this month?"
• "Is that the lowest amount you can accept, or could you check with a supervisor?"
• "If we agree, can you send the new amount to me in writing before I pay?"

Do not pay until you have the new amount in writing. After you pay, ask for a letter or receipt that says the account is paid in full or settled.

Step 5. Ask about a payment plan

A payment plan lets you pay the bill in smaller pieces over time. Ask for the lowest monthly amount you can honestly afford. Do not promise a number that you cannot keep.

• "Can I set up a payment plan with no interest?"
• "What is the lowest monthly payment that you can accept?"
• "Are there any fees for setting it up or for paying late?"
• "Will you put the full terms in writing, and will the account stay out of collections while I pay on time?"

Be careful with plans run through outside lenders, which can add interest. If a plan comes with interest or a new credit account, ask for the details first.

What if the bill was much higher than the estimate?

If you had no insurance, or chose not to use it, a provider generally has to give you a good faith estimate. This is a written guess of what your care will cost. CMS is the federal agency that runs Medicare. It says you may be able to dispute your bill if it is at least $400 more than the estimate. Read our guide on the good faith estimate for the steps. Keep your estimate, because it is your proof.

Tips that help on every call

• Stay calm and kind, because the person on the phone did not set the price.
• Write down the date, time, name and what was promised.
• Ask for every deal in writing before you pay.
• Keep paying anything you agreed to, so the account stays out of trouble.
• Ask for a supervisor if the first person cannot help you.

Next time you need care, ask for the price first. Our guide on doctor visit prices without insurance can help. If you think you are having an emergency, call 911 or go to the nearest emergency room. Hospitals must screen and stabilize you whether or not you can pay, and you can sort out the bill afterward. This page is general education, not medical or legal advice.