Negotiating a Hospital Bill: A Step by Step Guide

Start by Requesting the Itemized Bill

A hospital bill that shows only a total or a few summary lines is hard to question. Many people begin by asking the billing office for an itemized statement that lists each charge on its own line, with a code and a date. With that in hand, each line can be compared with what you understood about your care and your insurance paperwork.

Our guide to reading an itemized hospital bill walks through the usual columns. Hospital bills often list revenue codes for the department or type of service, along with CPT or HCPCS codes for the service or item. The five-character CPT codes on a bill come from a set that the American Medical Association maintains. CMS maintains the HCPCS Level II codes, which generally describe things like supplies, drugs and some services. Inpatient stays are often paid by MS-DRG. For a quick primer, see what CPT codes are.

Check the Bill for Errors and Duplicates

Reading the itemized bill line by line is a common next step. Some people look for the following:

• The same item or service listed more than once on the same date
• Dates or departments that do not match the visit
• Services they do not recall receiving
• Charges that seem to overlap between the hospital bill and a separate physician bill

That last item has a common explanation. A hospital or hospital outpatient department can charge a facility fee for the space, staff and equipment, while the surgeon, radiologist or anesthesiologist involved in the visit usually sends a separate professional fee for their own work. Two bills for one visit is common and is not automatically a mistake. Our explainer on facility fees and professional fees can help sort out which bill covers what.

If something looks wrong, the billing office can be asked to review that specific line and explain it in writing. For insured patients, comparing the bill with the insurer's explanation of benefits can also show whether the amounts match.

Compare the Charges With the Hospital's Published Prices

Since January 1, 2021, the CMS Hospital Price Transparency rule (45 CFR Part 180) has required each hospital in the United States to post a machine-readable file of its standard charges for all items and services. Those charges include the gross charge, the discounted cash price, payer-specific negotiated charges, and the de-identified minimum and maximum negotiated charges. The rule also calls for a consumer-friendly display of 300 shoppable services, or an online price estimator tool instead. In CMS terms, a shoppable service is one that a patient is able to schedule ahead of time.

Gross charges come from the hospital's chargemaster, its master list of list prices. What an insurer actually pays is a negotiated rate, and a good number of hospitals also set a discounted cash price for people paying on their own. Seeing these side by side can show where a bill falls. Our guide to cash prices and insured rates explains the difference.

On Clear Hospital Costs, hospital facility charges for common procedures are listed across Texas and Florida. These figures are hospital facility charges taken from the hospitals' own files, not total costs, so physician fees are not included. For the raw files, see how to use hospital price transparency files.

Ask About Self-Pay and Prompt-Pay Discounts

People who are uninsured, or who choose not to use insurance, can ask the billing office whether a self-pay or discounted cash price applies to the account. Some hospitals also discount prompt payment, though terms vary, so it can help to ask what the discount is, what it applies to, and how long it stays available.

Some questions people bring to that call:

• Is the discounted cash price in the posted file the one applied to this account?
• Is there a prompt-pay discount for paying the balance in full?
• Does the discount cover the facility fee only, or other charges too?

Our guide on how to ask for the self-pay price includes sample wording. For scheduled services, the No Surprises Act lets uninsured and self-pay patients get a good faith estimate of expected charges. A provider generally has to supply the estimate when the appointment is booked at least 3 business days in advance, and also whenever the patient requests one. Should the final bill from a provider or facility come in at least $400 above its good faith estimate, the patient may be able to use the patient-provider dispute resolution process. It generally must be started within 120 calendar days of the bill date. CMS runs a No Surprises help desk. More detail is in our good faith estimate guide.

Look Into Financial Assistance and Payment Plans

Nonprofit (tax-exempt) hospitals must meet IRS section 501(r) requirements. These include a widely publicized written financial assistance policy, limits on what eligible patients are charged for emergency and other medically necessary care (no more than the amounts generally billed to insured patients), and reasonable efforts to determine eligibility before extraordinary collection actions. Each hospital sets its own eligibility rules. Many other hospitals also offer assistance, with terms that vary.

The billing office can provide the financial assistance policy and an application, and can say which documents it uses to decide eligibility. Our guide to hospital financial assistance covers what these programs often look like.

If a balance remains, a payment plan is another option to ask about. Common questions are whether the plan charges interest, whether there are fees, and what happens if a payment is late. Getting the terms in writing before agreeing can make the arrangement easier to follow later. With a high-deductible plan, a member often pays the plan's negotiated rate for a service until the deductible is met, which can explain a large patient share. Our high-deductible health plan tips go into more detail.

Keep a Clear Paper Trail

Negotiations often take several calls. A simple record can keep things organized:

1. Write down the date, time and name of each person spoken with.
2. Note what was discussed and any reference or case number.
3. Ask for any agreed discount, adjustment or payment plan to be confirmed in writing.
4. Save the itemized bill, explanation of benefits, letters and any good faith estimate in one folder.
5. Keep proof of every payment made.

For a scheduled service, our guide to comparing hospitals by price and the methodology page explain how the numbers on this site are put together. If a medical emergency arises, the step to take is to call 911 or head to the nearest emergency room.