How to lower your medical bills: the complete guide

A big medical bill can feel final. It usually isn't. Bills can include mistakes, and insurers can process claims wrong. Nonprofit hospitals must also offer financial help, which you often have to ask for.

The order you work in matters. A lot of advice starts with negotiating. We suggest fixing errors and insurance problems first, so you don't negotiate over money you never owed. Then ask for financial help and discounts. Negotiate and set up a payment plan last.

To start, you'll need 2 documents: an itemized bill from the provider and, if you have insurance, your explanation of benefits (EOB). This guide covers all 6 steps, with a link to a full guide for each. A worked example at the end follows 1 bill from start to finish.

Asking is worth it. A 2024 survey in JAMA Health Forum asked adults about medical bills they disagreed with or couldn't afford. About 1 in 5 said they or someone in their household got one in the past 12 months. Among those who called the billing office about a mistake, about 3 in 4 said the bill was corrected. Among those who couldn't afford the bill and called, about 3 in 4 got some relief. That included financial aid and payment plans. These groups were small, so read the results as a good sign, not a promise.

Which problem do you have?

Find the row that sounds most like you. Each link goes to a full guide.

The 6 steps at a glance

Not every step will apply to every bill. Skip the ones that don't fit, but try the rest in this order.

Step 1: Check your bill for errors

Before you pay or negotiate, make sure the bill is right. It's easier to fix a bill before you pay it than to get money back later.

Get an itemized bill. A summary bill shows only totals. An itemized bill lists every charge, 1 line at a time, with dates and codes. If your bill doesn't show that detail, ask the billing office for it. Our guide on how to get an itemized bill includes a script and a letter.

Find your EOB. Your insurer sends an EOB for each claim, by mail or online. It shows what the provider charged, what your plan allowed and paid, and what you may owe. The Centers for Medicare & Medicaid Services tells patients to compare the EOB with the provider's bills. If something looks wrong, call right away.

Compare the 2. Start with the totals, then go line by line. Our guide to the EOB vs. medical bill walks through it. Our bill and EOB checker does the math for you.

Here's what to look for:

• The same charge listed twice
• A service you didn't get
• A quantity that looks too high
• A visit billed at a higher level than your records show
• An insurance discount or payment that's missing
• A wrong date, name, or insurance ID

Our list of common medical billing errors explains 12 errors to check for, and what to do about each. Our guide to duplicate charges on a medical bill shows how to spot a true repeat.

If you find a mistake, call the billing office and ask for a corrected bill. Ask them to hold your account while they check. If a call doesn't fix it, see how to dispute a medical bill.

Already paid a bill that turns out to be wrong? You can ask for your money back. See how to get a medical bill refund.

Step 2: Make sure your insurer processed it right

Sometimes a high bill is really an insurance problem. The claim may never have reached your plan. Or your plan denied it for a reason the provider can fix.

Check that the claim was sent. If you have a bill but no EOB, call your plan. Ask if it got a claim for that date. If not, ask the provider to bill your insurer. Our letter asking the provider to bill insurance first puts that in writing. If you have Original Medicare, the law requires providers to file claims for covered care for you.

Read the denial code. If your EOB shows a denial, look for a code. Some denials are paperwork problems the provider can fix and send again. Here are some codes you may see:

Our guide to denial codes on your EOB explains more. So does our guide for when insurance didn't pay your medical bill.

Check which plan paid first. If you have 2 plans, the right one needs to pay first. See coordination of benefits.

Appeal if your plan got it wrong. If your plan denied care it should cover, you can appeal. For most private plans, you have 180 days from the denial notice to file an internal appeal. If your plan says no again, you can ask for an external review. See how to appeal an insurance denial.

Check your surprise billing rights. The No Surprises Act, in effect since January 1, 2022, limits many surprise out-of-network bills. It covers emergency care and air ambulance rides. It also covers some care from out-of-network providers at in-network hospitals and surgery centers. In those cases, you usually owe only your in-network share. Ground ambulance rides generally aren't covered. See does the No Surprises Act apply to my bill.

Check for balance billing. For covered services, an in-network provider generally can't bill you more than your share on the EOB.

Ask the provider to hold your account until the insurance side is settled. There's no point in paying a bill that's about to change.

Step 3: Apply for financial assistance or charity care

Once the bill is right, ask what help the hospital offers. Financial assistance, often called charity care, can lower a bill or cover all of it.

Nonprofit hospitals must have a written financial assistance policy. Some other hospitals have one too. Under federal tax rules, a nonprofit hospital's policy must:

• Explain who qualifies, and whether help means free or discounted care
• Explain how to apply
• Be posted on the hospital's website, with free paper copies if you ask
• List which doctors and other providers at the hospital it covers

If you qualify at a nonprofit hospital, there's a limit on what it can charge. For emergency or other medically necessary care, it can't charge you more than it generally bills people with insurance.

You can apply after you get the bill. A nonprofit hospital must accept applications for 240 days after the first bill it sends after your care. While it reviews a complete application, it must pause serious collection steps, like credit reporting or a lawsuit. If you qualify after you've paid, it must refund what you paid beyond what you owed.

Expect to show your income. The hospital may ask for proof, like pay stubs or a tax return. Send copies and keep the originals. If your application is missing something, a nonprofit hospital must tell you what it needs. It must also give you a reasonable chance to finish it.

Ask even if you have insurance. Each hospital sets its own rules and income limits. Some policies also help people with insurance who can't afford their share. Read the policy before you decide you don't qualify.

Our guide to hospital charity care explains how to apply. Our charity care screener shows how your income compares with the federal poverty guidelines. Our financial assistance request letter helps you ask.

Step 4: Ask for a self-pay or prompt-pay discount

If you don't qualify for financial assistance, or it doesn't cover the whole bill, ask for a discount.

Self-pay discounts. If you don't have insurance, ask for the self-pay price, sometimes called the cash price. Hospitals must post the discounted price they accept from people who pay cash. That includes at least 300 common services you can schedule ahead. Our guide on how to look up what a hospital charges shows where to find it.

Prompt-pay discounts. Some providers take a little off if you pay the full balance quickly. They don't have to, so ask. Only take this deal if you can pay without borrowing at high interest.

Good faith estimates. If you're uninsured or not using insurance, you have extra rights for scheduled care. Providers must usually give you a good faith estimate when you schedule at least 3 business days ahead, or when you ask. If a provider's bill is at least $400 more than its estimate, you can dispute it. You have 120 days from the bill to start. See good faith estimates.

Our guide to self-pay discounts on a medical bill explains how to ask.

Step 5: Negotiate what's left

By now, the bill should be correct, and you've used every discount you qualify for. If what's left is still more than you can pay, negotiate.

• Call the billing office and ask for someone who can approve a lower amount.
• Be specific. Say what you can pay, either in total or each month.
• Ask if they'll accept a lower amount as payment in full.
• If you can pay a lump sum, say so. Some providers take less for money now.
• Get any deal in writing before you pay.

Here's a short script you can adapt:

I've checked this bill, and I've applied for financial assistance. I can't pay the full balance of $[amount]. I can pay $[amount] now if you'll accept it as payment in full. If not, can we set up a payment plan with no interest?

Our guide on how to negotiate a hospital bill covers what to say. Our hospital bill negotiation script gives you the words.

In the 2024 JAMA Health Forum survey, 10 of the 14 people who called to negotiate said the price went down. That's a small group, but it shows asking can work.

If you'd rather not make the calls, a medical bill advocate can negotiate for you. Ask how they charge before you agree.

Step 6: Set up an interest-free payment plan

If you still can't pay the balance at once, ask the provider for a payment plan. Some plans have no interest. Others are really loans, so ask before you agree.

Ask for:

• No interest and no fees
• A monthly amount you can keep up with
• The full terms in writing
• What happens if you miss a payment

Be careful with medical credit cards and loans. They're often offered at the front desk or the billing office. Many start with a period of no interest. The Consumer Financial Protection Bureau (CFPB) warns about what happens next. If you miss a payment or don't pay the balance in time, interest can be charged on the full amount. After the promotional period, rates can reach 25% or more in some cases.

The CFPB suggests you first ask about financial assistance and what your insurance covers. Only then agree to a payment plan or a medical credit card. That's why this step comes last.

Our guide to medical bill payment plans explains how to ask. Our payment plan request letter puts it in writing. If you can't afford your bills even with a plan, see what to do if you can't afford medical bills.

Keep paying what you agreed to. If your situation changes, call before you miss a payment.

What if the bill is already in collections?

A collection notice isn't the end of the road. You have rights, and the steps above still apply.

A debt collector must give you validation information about the debt. If you send a written dispute within 30 days, it must stop collecting until it verifies the debt. You can still ask the hospital to fix errors and apply for financial assistance. Our guide to a medical bill in collections explains your rights, and our debt validation letter helps you respond.

Keep a record as you go

Each step can take a call, a letter, or both. A simple log saves you from starting over. For each contact, write down the date, who you talked to, what they said, and what happens next.

Keep 1 folder for each visit, with the bills, EOBs, letters, and receipts. If you need to escalate later, this record is your proof. It also helps if someone else, like a family member or an advocate, takes over.

Bills from a specific kind of care

Some care brings several bills at once, from the hospital and from each doctor who treated you. Our guides by type of care show which bills to expect and what goes wrong most often:

• Emergency room bills
• Bills after surgery
• Hospital stay bills

Say Andre has a Marketplace plan with a $3,000 deductible, and he hasn't paid any of it yet this year. He goes to an in-network emergency room. His EOB says he owes $1,100 for the visit, IV fluids, and lab tests, all toward his deductible. But his first bill asks for $4,800.

That's $1,100, plus $3,400 for a CT scan his plan denied, plus a second $300 charge for IV fluids. Here's how he works through it.

Step	What Andre found or did	Amount due
Start	First bill from the hospital	$4,800
1. Check for errors	IV fluids were listed twice on the same date, but the EOB showed only 1. The hospital removed the $300 duplicate.	$4,500
2. Check the insurance	The CT scan was denied with code 16, for missing information. The hospital fixed the claim and sent it again. His plan allowed $1,000, which went toward his deductible.	$2,100
3. Apply for financial assistance	The hospital's policy gave people at his income a 60% discount.	$840
4. Ask about discounts	The hospital offered 10% off for paying in full within 30 days. He couldn't pay it all at once.	$840
5. Negotiate	He asked if they'd take $700 as payment in full. They said no.	$840
6. Set up a payment plan	12 monthly payments with no interest	$70 a month

Here's the math. Removing the duplicate took $4,800 down to $4,500. The CT scan went from $3,400 to his $1,000 share, a $2,400 drop, leaving $2,100. That matches his new EOB: $1,100 plus $1,000. A 60% discount took off $1,260, leaving $840. And $840 over 12 months is $70 a month.

Results vary. Steps 4 and 5 didn't lower Andre's bill, and that's OK. Each step is still worth asking about.

When to get help

You can work through many bills yourself with a few calls and letters. It's worth getting help when:

• The bill is large, or the billing office can't explain it.
• Your insurer denied the claim, and an appeal deadline is close.
• The bill is in collections, or you've been sued.
• You're handling bills for someone else and you're short on time.

Here's where to turn:

• Your insurer's member services. It can explain a claim or a denial. The number is on your insurance card.
• Your state insurance department or consumer assistance program. Many states have a consumer assistance program that helps with insurance complaints and appeals.
• The No Surprises Help Desk. For surprise out-of-network bills, call 1-800-985-3059.
• Nonprofits. Dollar For helps people apply for hospital charity care for free. Patient Advocate Foundation offers free case management to people with a serious illness.
• A medical bill advocate. A medical bill advocate can take on the calls and letters for you.
• An attorney. If you've been sued over a medical bill, talk to an attorney right away.