IE 11 is not supported. For an optimal experience visit our site on another browser.

How to negotiate and avoid costly medical bills

Going to the doctor can be stressful before, during and after an appointment. These tips can help.
Finding a doctor you trust can be challenging, but finding one in-network can feel almost impossible. TODAY illustration / Getty Images

Medical debt is crippling millions of Americans’ finances — according to analysis from Credit Karma, about 20 million of its members owe a collective $45 billion in medical debt. Going to the doctor can be stressful enough without contemplating a costly bill, yet nearly a third of Americans have forgone care due to the fear of rising costs, per a recent Bankrate survey.

When you need to see a doctor, here are four things you need to know to protect yourself and your credit.

1. Understand your coverage.

Reading your health insurance plan may seem confusing, but it is vital to helping you avoid unwanted bills at the hospital. Understanding your insurance is the first line of defense, explained Raymond Kluender, associate professor at Harvard Business School, and that includes knowing what options you have if you are not insured. “If you're not insured, most hospitals have financial assistance programs that you may qualify for, and they can also often help you enroll in Medicaid if you're qualified for that,” Kluender said.

Additionally, understanding the bigger picture when you undergo a procedure can help you navigate billing. “Consumers tend to think of a procedure in a very singular way, so if they're getting a colonoscopy, for example, they just think of what the gastroenterologist’s bill is,” said Robin Gelburd, president of FAIR Health. “There's a three-dimensional component to healthcare. There will be the anesthesia associated with that, there may be pathology if there's a biopsy, and so forth.”

2. Do some cost comparison.

Finding a doctor you trust can be challenging, but finding one in-network can feel almost impossible. If you do choose to go out-of-network for your coverage, look carefully at your insurance plan, and use online tools to assess what the cost of certain procedures are in your area.

"You can still do some homework, you can go to sites that offer cost, [FAIR Health has] listed all the different procedures based on very specific geographic regions and you can get a sense of what is typically charged,” Gelburd explained. “You should feel free to open up a conversation with your provider about what you've learned.”

3. Get ready to negotiate.

When you do receive a bill you weren’t expecting — or is higher than anticipated — you can likely negotiate with your provider or with your insurance company to get a fair rate.

When you’re dealing directly with a hospital or healthcare provider, before a bill gets sent to collections, “the bills can often be negotiable, and hospitals will often work with you to find a payment plan that works for you,” said Kluender. “You should not necessarily pay bills that you think were made in error or that you think you should not rightfully owe.”

If you’re in talks with your insurance company, let them know if you are charged beyond what you expect - they may even talk to your provider for you. “There's always the opportunity for the consumer to call the plan to let them know about that surprise bill to see whether there's any relief on the plan side that they will sort out with the provider,” Gelburd explained.

4. Don’t beat yourself up.

If you're faced with a bill you can’t pay, or have one in collections, you’re in good company — millions of people are dealing with the same issue. You don’t need to feel shame about it. “I will say that having a medical debt sent to collections is not the end of the world … the way that credit bureaus are treating medical debt and collections is evolving a lot over the past few years, so the penalty for your credit score will be much less,” Kluender said. “You have rights, and you can be strategic in the way that you deal with this.”