How to negotiate a hospital bill (what to say, what to ask for)

You've checked your hospital bill, and it's right. It's still more than you can pay. That's when it makes sense to negotiate. This guide shows you how to negotiate a hospital bill: what to check first, what to ask for, and what to say. It's part of our guide on how to lower medical bills.

Negotiating isn't rude. Billing offices talk about discounts and payment plans every day. Your job is to know your numbers and ask clearly.

What can you ask for?

Most hospitals have more than 1 way to lower a bill. Here's what to ask about, and when each one fits.

You can ask for more than 1. For example, you might get a self-pay rate and then a payment plan for that amount.

Step 1: Make sure the bill is right

Ask for an itemized bill that lists every charge. Our guide on how to get an itemized bill has a script and a letter. If you have insurance, compare it with your explanation of benefits (EOB).

Look for repeated lines, services you didn't get, and missing insurance payments. Our list of common medical billing errors shows what to check. If you find a mistake, get it fixed before you negotiate. See how to dispute a medical bill.

Step 2: Ask to be screened for financial assistance

Financial assistance, often called charity care, can lower a bill or cover it in full. Nonprofit hospitals must have a written financial assistance policy. If you qualify, they can't charge you more for emergency or other medically necessary care than they generally bill people with insurance.

The Consumer Financial Protection Bureau (CFPB) notes that these programs can help people with insurance, not just people without it. So ask even if you're insured. Our guide to hospital charity care explains how to apply.

Apply before you put the bill on a credit card. The CFPB warns that once a hospital bill is on a credit card, financial assistance may be harder to get.

Step 3: Look up the hospital's own prices

Since January 1, 2021, hospitals have had to post their prices online. They must post a full file of standard charges for all items and services. They must also show prices for at least 300 shoppable services, the kind you can plan ahead, in a consumer-friendly format.

The full file lists several prices for each service:

• Gross charge. The list price from the hospital's chargemaster, before any discounts. This is often the first number on your bill.
• Discounted cash price. The price for someone who pays cash.
• Negotiated rates. The rate the hospital agreed to with each insurer.
• Lowest and highest negotiated rates. The lowest and highest rates it agreed to across all insurers.

These numbers give you a fair starting point. If you don't have insurance, the discounted cash price is the hospital's own number for people who pay on their own. The lowest negotiated rate shows the least the hospital agreed to accept from any insurer for that service.

If you have insurance, your share is usually based on the allowed amount on your EOB. The posted rates can help you check that your plan's price was applied.

Prices for your exact care may be hard to match. Use them as a guide, not a promise. Our guide on how to look up what a hospital charges shows where to find them.

Step 4: Decide what you can pay

Before you call, pick 2 numbers:

1. A lump sum. The most you could pay now without a high-interest loan or credit card.
2. A monthly amount. What you can keep paying every month, even in a tight month.

Be honest with yourself. A deal you can't keep up with can leave you worse off. If neither number covers much of the bill, say so. That's useful information for the billing office.

Step 5: Call and ask

Call the billing office. Ask for someone who can approve a lower amount or a discount. That may be a supervisor or a financial counselor.

Here's a script if you don't have insurance.

Hi, I'm calling about account number [number] for [patient name]. I don't have insurance, and I've checked the itemized bill. I've also applied for financial assistance. The bill is $[amount]. Your posted cash price for this care is about $[amount]. Can you bill me at your self-pay rate? If I pay within 30 days, is there a prompt-pay discount?

Here's a script if you have insurance.

Hi, I'm calling about account number [number]. My bill matches my EOB, and I owe $[amount]. I can't pay that all at once. Can you screen me for financial assistance? Do you offer a discount if I pay part of it now? If not, can we set up a payment plan with no interest?

Here's a script for a lump-sum offer.

I can pay $[amount] now. Will you accept that as payment in full and close the account?

Then stop talking and let them answer. If they say no, ask what they can offer. Ask if a supervisor can review it. Write down every number they give you.

Our hospital bill negotiation script has more lines for common replies.

Step 6: Ask for a hold on collections

Ask the billing office to hold your account while you talk. Note who agreed and the date. A hold is usually a request, not a right.

Some rules do help. While a nonprofit hospital reviews a complete financial assistance application, it must pause serious collection steps. Those include credit reporting, selling the debt, and lawsuits. Nonprofit hospitals also can't start those steps until 120 days after the first bill after your care. They must send written notice at least 30 days before they act.

If a collector already has the bill, tell it you're applying for financial assistance. Ask it to pause while you wait.

Step 7: Get the deal in writing

Don't pay until you have the agreement in writing. A letter, an email, or a portal message all work. It should include:

• The account number and the original balance
• The new amount you'll pay
• For a lump sum, a statement that it settles the account in full
• For a plan, the monthly amount, number of payments, and no interest
• That the account won't go to collections if you keep to the terms

After you pay, check that your next statement shows a $0 balance or the new plan. Keep the letter and your receipts. Our guide to interest-free medical payment plans explains more about setting up a plan.

Say Andre doesn't have insurance. He has an outpatient MRI and a follow-up visit at a hospital. He checks the itemized bill, and it's correct. His income is above the limit in this hospital's financial assistance policy.

He looks up the hospital's posted prices.

Service	Billed (gross charge)	Posted cash price
MRI	$4,800	$1,500
Follow-up visit	$1,200	$500
Total	$6,000	$2,000

He calls and asks for the self-pay rate. The hospital agrees to bill him $2,000. It also offers 10% off if he pays in full within 30 days. That's $200 off, for a total of $1,800.

Andre can't pay $1,800 now without a credit card. So he asks for a plan instead. The hospital agrees to $200 a month for 10 months with no interest. That's $2,000 in all.

The plan costs $200 more than the prompt-pay price, but it adds no interest. Either way, he pays $4,000 less than the $6,000 first billed.

Results vary. Another hospital might offer less, or more.

If you don't have insurance: check your good faith estimate

If you scheduled care at least 3 business days ahead, you should have gotten a good faith estimate. If a provider's bill is at least $400 more than its estimate, you can start a federal dispute. You have to start within 120 days of getting the first bill. See good faith estimates.

If this doesn't work

If the first call doesn't lower the bill, you still have options:

• Ask again later. A different person or a supervisor may have more room to say yes.
• Put your offer in writing. Send a short letter with your offer and the numbers behind it.
• Ask for a payment plan anyway. Even if the price stays the same, a plan with no interest spreads it out.
• Look at other help. Our guide on what to do if you can't afford medical bills lists every option.
• Don't ignore court papers. If you're sued over a medical bill, talk to an attorney right away.

When to get help

You can often negotiate a bill yourself with a few calls. It's worth getting help when:

• The bill is very large, or it's from several providers.
• The hospital won't talk to you about a discount or a plan.
• The bill is in collections, or you've been sued.
• You're handling bills for someone else and you're short on time.

A hospital financial counselor can explain the financial assistance policy and help you apply. Dollar For, a nonprofit, helps people apply for hospital charity care for free. A medical bill advocate can make the calls for you. Ask how they charge before you agree.