Negotiating hospital bills can be tiresome and feel like an endless storm. That’s because hospitals intentionally designed their systems to be difficult to navigate. Fortunately, Fairdoc is here to help you. We’ve compiled all the most important strategies for hospital bill negotiation for your ease, including how to:

• Access your bill

• Check your bill for errors

• Dispute with the hospital

Before beginning, though, we want to emphasize one key point: you have time. Even though the hospital might pressure you, saying you have to pay now, that’s not true. Legally, your bill must wait 120 before it’s allowed to enter collections. Beyond that, it takes 12 months before a bill can begin affecting your credit score. Be patient. You have time.

Access Your Bill

When it comes to hospital bills, there are three key types: regular hospital bills, itemized bills, and UB-04s. Each of these functions differently. 

The regular hospital bill shows you the basic outline of your payments. Second, itemized bills show you each item you paid for in an itemized, database-like fashion. Best of all are UB-04s: these are what hospitals send your insurance, and unlike itemized bills, they are strictly defined and can’t be fudged or tampered with.

“When it comes to hospital bills, there are three key types: regular hospital bills, itemized bills, and UB-04s.”

First to arrive will be your hospital bill. Sent automatically, this bill lists total charges and discounts, shows you your insurance coverage, and tells you what you owe. It’s wise to check the bill for lines like “insurance adjustments” or “billed to insurance” to ensure that your provider is actively participating in the billing process. Additionally, insurance providers will tell you if they’re processing the bill or not by sending you an Explanation of Benefits (EoB) in the mail; if you haven’t received an EoB, you can check your online insurance portal.

To receive your itemized bill or UB-04, you have to call the hospital. Beginning with the itemized bill, a couple of key points hover around that you need to know. First of all, the regular hospital bill you receive often looks itemized. Don’t let that deceive you. It usually isn’t. To receive a properly itemized bill, call the billing department of the hospital and simply ask them for one - and don’t take no for an answer. Since they’re legally required to give it to you within 30 days of asking, keep your inquiry direct and clear: “I’m asking for the itemized bill from my visit two weeks ago. My name is…” While you’re on the phone, there are a few other things that it doesn’t hurt to ask the hospital about:

• Do I qualify for financial assistance?

• Can you extend my payment deadline?

• Do you offer discounts or payment plans?

Superior to the itemized bill, hospitals use UB-04s when they communicate with insurance providers. The UB-04 is the claim your hospital sends to your insurance provider. These serve you more usefully than itemized bills because UB-04s are strictly defined, can’t be fudged, remain itemized, and contain many helpful variables. UB-04s always present themselves in an arrangement of 81 fields, with variables including:

• Procedures

• Revenue codes

• Descriptions

• CPTs

• CPT modifiers

• HCPCS

• Unit quantity

• Charges

• Diagnosis-Related Groups (DRGs)

Check for Errors

Billing errors appear in two forms: upcoding and downcoding. Downcoding benefits the patient, like a bank error in your favor. On the other side, upcoding is overbilling patients. Upcoding entails quoting a more expensive medical procedure on the bill than the hospital actually performed (charging for chronic rather than acute conditions, for instance) and can have serious consequences, all the way up to a lawsuit for defrauding the patient.

We don’t need to sue anyone yet, though. We’re here to make confusion clear.

Within the field of upcoding, we’ve noticed five common types of errors:

• General mistake

• Duplicates or Inflated quantities

• Unreceived treatments

• False surgery times

• Wrong room fees

The ease of detecting these errors has increased since the Price Transparency Rule, but many hospitals unfortunately lag behind that rule and ignore it. Another tactic hospitals use to dodge this, they often publish their prices in a non-user-friendly format.

Each type of error has countless examples. Here are a few to clarify what they mean:

• A general mistake could be someone recording a sprain as a break, or a headache as a migraine. 

• A duplicate could involve someone writing you down for 50 aspirin instead of 5.

• Unreceived treatments include items like x-rays you were about to receive, but cancelled, but the hospital still charged you for.

• A false surgery time gets a little more complex: hospitals charge in the operating room (OR) by the minute, so if a coder records your surgery times falsely, it could inflate the prices, often significantly.

• Last, a wrong room fee could involve being charged for a single room instead of a shared room.

Dispute the Hospital

Now it’s time to get into the action. Hospital bill disputes aren’t complicated, but they can be exhausting. 

“Hospital bill disputes aren’t complicated, but they can be exhausting.”

First, send the negotiation letter. Send it to the hospital’s billing or settlements department, and keep it to one page. Within that one page, make your case strongly. Present financial insecurities, billing errors, and any other key items that demand financial compensation. Once you send your letter, call the hospital to ensure they received it and ask for a time estimate for resolution.

When you call, keep a few things in mind about the hospital administrators. First, they don’t know legal codes and haven’t been trained on your HIPAA right of access to medical records. If they know about those, then it’s all the easier for everyone, but if they don’t, that isn’t their fault. Second, they’re often overworked and underpaid. They have a difficult job. Be patient. Despite those things, be insistent also; don’t take no for an answer; when requesting an itemized bill, UB-04, or other records, kindly demand them.

If you think you don’t have a case, you probably still do. Half of all bills have something wrong that only experts catch, and half of those have something wrong from a medical necessity point of view, meaning a quarter or more of all hospital visitors received treatment they didn’t need and a bill they didn’t deserve for it.

Conclusion

All said, there are three steps to negotiating your hospital bill: first, access the bill by calling the hospital's billing department and request an itemized bill or UB-04. Next, check it for errors. Finally, write a short but strong letter to the hospital and let the cards unfold.

We hope this article answered all your hospital bill negotiation questions! At Fairdoc, we are here to inform you, assist you, and answer all your questions. If you have any inquiries for us, feel free to reach out, and stay tuned for future articles!