How to Deal With & Negotiate Healthcare Bills in the US

by ass_goblin_04

I am on the finance side of healthcare and know every single cost involved with seeing you as a patient. I’ll try to answer as many questions as I can on this post.

1) If your claim was denied by insurance as 100% patient responsibility contact the billing department and request a self pay bill. It should be roughly 30-40% of the original invoice received.

2) If you got labs that are denied do the same thing but contact the lab service that billed you rather than the doctors office. Self pay rates for labs are about 20% the amount of the regular invoice. You can also work something out where the labs get billed to the doctor and then you pay the doctor instead. The doctor will be charged significantly less (usually about 85% less). I have seen this done to reduce a large $2,400 lab bill down to $450. A vast majority of labs true cost is under $25.

3) A vast majority of medical providers will not send you to collections if you stay in contact with them. Most organizations will write off all unpaid claims after 12-18 months so they will accept anything you’re willing to pay.

4) Almost every single injection or drug administered via needle or IV will get reimbursed less than $1.00 by insurance unless it’s a vaccine. Fight those the hardest. Insurance pays about 2% on average on those.

5) The best thing you can do is delay the payment as long as possible if you can’t afford it. This was bad debt adjustments and contractual adjustments have been factored in and you’ll be able to negotiate it better. However, this does not mean never pay the bill.

6) Supplies used for your visit cost roughly $6.00 on average. This includes the basic needles, any vital checking equipment, swabs, etc…

7) Average single doctor rates are around $105-$120 for an MD and $50-$55 for a PA/NP (not including bonuses, additional incentives, or on call rates). If you get a PA/NP you can fight the cost more due to insurance applying a 15-30% discount on those claims.

8) Always be nice to the billing staff. They are the ones with the most power to help you. They make notes in the EMR system that allow future billers to follow up and they may be more lenient on your payment timing if you work with them. They will also be the ones who decide if a payment plan can be used to help take the burden off a large lump sum payment.

I hope this helps.