5 Hospital Bills You Should Never Pay Without Negotiating First
According to the Commonwealth Fund, a private foundation that advocates for improvements to the healthcare industry, most people who receive inaccurate, unexpected or excessive medical bills don’t challenge them, but doing so is often worth the effort.
The fund's research found that 45% of working-age adults received bills for services they believed were covered by insurance, yet fewer than half of those who reported billing errors challenged them or tried to negotiate the cost, usually because they didn’t understand their rights or know how to advocate for themselves. That’s unfortunate, considering the likelihood of a positive outcome. Nearly 40% of those who sought relief ultimately had their bills reduced or even eliminated.
According to research from the University of Southern California, self-advocacy is essential and those who challenge hospital bills have a good chance at success, especially in the following cases.
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1. ‘Surprise’ Bills for Out-of-Network Services
The No Surprises Act, effective since 2022, is federal legislation that shields patients with most types of private, workplace and marketplace health insurance from unexpected medical bills for out-of-network (OON) services received in emergency rooms, from air ambulance services and for non-emergency care related to in-network hospital and surgical center visits.
Never pay these kinds of bills without understanding your rights. Many can be challenged, especially when you didn’t have a choice in which hospital you received care.
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2. Bills Higher Than the Good Faith Estimate You Received
The No Surprises Act can also help your case, even if you don’t have or don’t use insurance. The law shields the uninsured from bills exceeding $400 if they did not receive a good-faith cost estimate for care scheduled at least three days in advance or if the bill they do receive is substantially higher than the quoted estimate.
3. Any Bill That Doesn’t Match Your Explanation of Benefits
According to HealthEdge Wellframe, the No. 1 rule of medical bills is never to pay one before you’ve received your insurance company’s explanation of benefits (EOB).
Your EOB is a packet of documents labeled “this is not a bill,” which explains how much the hospital charged, what your insurance company covered and what it expects you will owe.
Your medical provider might have sent a bill before billing your insurer or simply could have made an error. Either way, the bill should match the EOB — always challenge one that doesn’t.
4. Itemized Bills You Don’t Understand
Goodbill is a platform that uses AI to help users uncover medical billing errors and secure payment reductions. It notes that many hospitals don’t send itemized bills unless patients request them, which they always should.
Itemized bills will contain line-by-line entries coded into the industry’s universal language for cataloging medical procedures and determining prices. Medical coding can be difficult for laypeople to decipher, but never take for granted that you received all the services listed in coded language that you don’t understand. Consider running your itemized bill through a service like Goodbill or contact your insurance company and medical provider for clarification of any entry you can’t interpret.
5. Any Bill Containing Errors — Even Small Ones
According to Time, errors are common on hospital bills. They’re often minor and clerical, such as incorrect addresses, but not always. Errors can be significant, including services not received or even bills for entirely different people. However, you should challenge any bill that contains an error, no matter how trivial the error may seem.
This article was provided by MoneyLion.com for informational purposes only and should not be construed as financial, legal or tax advice.
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