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How to Negotiate Medical Debt

Rules For Negotiating Your Medical Bills

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Betsalel Cohen
UpdatedOct 17, 2022
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    4 min read
Key Takeaways:
  • Remember that cash flow is king for medical offices.
  • Be tactful and polite in your negotiations.
  • Research will help you achieve a successful result

Medical debt is common. But can you negotiate medical debt?

Less than 15% of consumers have asked their physicians to negotiate their medical bills. Approximately 40% of people who ask for a discount get one.

Many medical providers and hospitals offer programs where patients who can prove they have financial hardship are offered discounts, some of which are significant. The medical provider will either deny the discount, grant a steep discount, or write off the balance completely. For wealthier cash-paying customers who can pay immediately, discounts range from 20% and 50% off of the normal charge. Discounts may still apply for people who pay off their medical bills over a short period.

Here are three helpful tips to keep in mind when negotiating medical debt:

1) Cash-Flow is King

Medical providers care about their cash flow and want to receive payments quickly. You can negotiate with your medical provider by stating you will pay cash if offered a discount. This is usually effective. Medical providers know there is a risk of receiving full payment on a patient's balance. Many people and insurance companies take too long or do not pay. They will work with people who are willing to pay something.

2) Negotiate Carefully

You probably do not want to negatively impact your relationship with a provider you see frequently. If requests to the billing office do not give you your intended result, tactfully ask your physician directly. This may be more effective. But weigh the cost of losing the relationship if you insist on a discount. See Six Steps To Successful Negotiation below to learn how to negotiate tactfully.

30 Do Your Research

Sometimes the most effective method of receiving a discount on your medical bill is doing a little research. Suppose you can prove that your physician bills are higher than similar p

These three rules apply to medical providers.

You need to know the six general rules for successful negotiations that work in all situations.

Six Steps To Successful Negotiation

Follow these six steps whenever you need to negotiate almost anything with anyone.

1) Be Polite

Politeness gets you further than anything else when negotiating with a creditor or anyone else. After all, creditors are humans too. Some in the service business spend most of their time dealing with angry and demanding customers, so you may find that by being courteous, the person you speak to will be more likely to give you what you want. Want proof politeness matters? Think of the last time you gave a big tip to a rude waiter or waitress.

2) Be Specific

Let the creditor know that your goal is to resolve the bill. The medical provider is under no obligation to give you a steep discount or a payment plan. However, if you do not ask, the answer is always no.

3) Be Flexible

Let the creditor know you are willing to accept a reasonable compromise. Medical offices need to pay their bills, too. If you present a "win-win" situation, then the medical provider can feel good about the negotiation.

4) Be Realistic

Some creditors refuse to negotiate initially. Don't take it personally. Try again at a later date.

5) Be Persistent and Methodical

Negotiation takes time and effort. As with many things in life, hard work and persistence will help improve your chances of success. Record the names and phone numbers of the people you speak to. Document the date, time, and results of each phone call.

6) Get It In Writing

If you negotiate a significant discount, get the agreement in writing before submitting your payment. This is the proof you'll need in cases where a creditor fails to correctly note the deal in your file and later tries to make additional claims on your account. You can ask them to send the agreement letter by mail or fax. Or, if the billing office is local, stop by and pick up the agreement in person and make an immediate payment. Make sure the offer letter is signed on the provider's letterhead.

Other Options For Medical Debt

If you cannot negotiate the medical bill by yourself, you have other options available. The most common are debt consolidation loans, consumer credit counseling, and debt settlement.


JJan, Jan, 2013
I have surgery (shoulder replacement) scheduled in the next couple of weeks. I have insurance through the school where I am employed but I need to negotiate my portion of the expenses with the physician and the hospital. My insurance will pay 15% of both expenses but that could be extremely costly and I'm told that payment for my portion will be expected at pre-op appointments. I am a single mother, work in education and simply don't have that kind of disposable cash available. What is the best route to take in trying to negotiate reduced payments?
BBill, Jan, 2013
I am surprised a person's health insurance will pay only 15% of the total cost of the bill. Perhaps you have a high deductible, or are electing for surgery in a facility not in your plan, or your doctor in not in your health insurance network. If you can't cut your costs by changing doctors or where the surgery is taking place, then you have two options I see: 1. Do not have the surgery. This is likely a painful option, and I mean that literally. 2. Talk to the doctor and the surgery center about payment plans in advance, well before the day of the surgery. Explain the insurance issue, and see what, if any, payment plans they offer.

Readers, I welcome your constructive suggestions for Jan.

RRyan, Jul, 2012
Thank you for the great information here. I am starting to feel a little bit better about my situation.

Recent my wife had to visit a local ER due to severe abdominal pains which were found to be a miscarriage from a 3 month pregnancy. We then had to travel to another hospital where her ob/gyn could perform a D&C. I am a young high school teacher with very bad high deductible insurance and my wife is unemployed due to the recession. We have about $1,500 in a HSA, and a little cash in our savings, but fear our medical bills are going to be outrageous due to going to two different hospitals and with all of the tests, anesthesia, surgery, etc. We would like to negotiate a lower bill, but we are new to this. Should we wait until we get the bill after its been applied towards our deductible or be proactive and call the hospitals ASAP? Should we argue what should be or is a fair price of these procedures in other markets? Aside from always being courteous and polite, what are a few things we should really do regarding these in coming bills from the hospitals? Any and all help would be great.
BBill, Jul, 2012
I do not see an advantage for you to call the billing departments at both hospitals before the "final" statements arrive. Who knows, a miracle may have occurred and all of the service providers at both hospitals may be in your plan. You may have liability for your deductible and nothing more.

I love your idea of comparing the prices for services with market prices. It would be great if hospitals would publish the prices for common procedures so that people could compare. Alas, I know of no reliable source for that information.
BBill, Mar, 2012
I had a heart attack and was hospitalized early this year in N. Michigan. My "Limited Benefit Plan" max'd-out and now I owe over $45k to the Hospital. I applied for some assistance but they told me that because I had ANY insurance (even garbage insurance), I did not qualify. After my heart attack I applied to BCBS and was accepted with a 6-month pre-exist exclusion. I told the Hospital 'BCBS would pay you 52% of the bill, why can't I set up an arrangement similar to this?' They told me 'we don't do things that way...'I want to pay my expenses but I am now buried in debt. I was healthy, so I thought and never gave a heart attack much of a thought, but it happened. The Hospital told me that the minimum they would consider is $400/month but I can't afford this level of payment. My script coverage is already max'd-out and this will cost me another $200/month on top of my new BCBS premium.I don't want to lose my house, I don't want to claim Bankruptcy and I do not know how to handle this. I have to get out from much of this and I need avenues to look into for options. If I mess this up I will kill my credit, whatever is left of it. I am just getting some work after 5-months of extremely limited income.
BBill, Mar, 2012
Every debt resolution strategy has pros and cons. Look at all of your options, including bankruptcy objectively and unemotionally. Consider: • Credit counseling if you can afford to repay about 3% or more of your balance due each month. This repays the entire balance over 5 years if the credit counseling agency can convince your creditors to sign onto a debt management plan. • Debt settlement is an aggressive strategy that will resolve most debts in three to four years. You mentioned your credit score was harmed due to your recent setbacks, so the main disadvantage to debt settlement — a lowered credit score — is not an issue for you. Look at this option closely. • Bankruptcy will resolve the debt quickly if you qualify for a chapter 7 discharge. If you do not qualify for a chapter 7, chapter 13 will create a payment plan you can afford for five years. Look at your options objectively and follow the links I mentioned to learn more about the pluses and minuses of each. No solution is pain-free, and every person's priorities are different. Do not be stunned into inaction because you make perfect the enemy of the good.
DDeLonda, Jan, 2012
I was informed that Tennessee has a law giving self pay patients a 51% discounts on their medical bill. I've gotten them before. One place I'm dealing with is refusing to give me the discount but I know it exists. Could you tell me where to look to find this? Please answer soon. Thanks
BBill, Jan, 2012
I could not find any information about the program you mention, when I did a online search. If any readers have information, I invite them to share it.

Perhaps you can check with your elected state representative, to see if his or her office can guide you.
PPolly, Jan, 2012
Hello bill. I have been searching this site for some information. I recently received a bill for medical back in 2006. actually the letter stated the bill date as nov 2011. I called and asked what this was and they apologized and said the real date was jan 19 2006 just days before the statue of limitations in Nevada 6 years. i had some other bills with the company that were paid off in July of last year. I am mad that first this is the first bill i have ever seen of this and second i had them look and make sure that we had everything in July. I am planning on doing a validation letter. but i have no intention of paying what rights do I have?
BBill, Jan, 2012
If you had the procedures and you actually do owe the debt, then the best thing you can hope for is that the debt's statute of limitations has expired or that they cannot validate the debt... or that they concede and agree to waive the bills.Make sure that you communicate with them that you know your rights and the facts of the situation, and then you may want to make a low ball offer to settle the debt for less than the full value so that you can get the debt resolved and also get it off of your credit report.