Key points
- Negotiation is a request, not a right. Providers decide, and we found no reliable figure for what discount to expect.
- Do the checks first: match the bill to your Explanation of Benefits, ask for an itemized bill, and apply for hospital financial assistance.
- Make a specific offer in writing, expect a counter-offer, and do not pay until the agreement is in writing.
- Do not settle an amount your plan may still owe while an appeal is open.
You can ask a provider to lower a bill. The order matters. Check that the bill is right, apply for financial assistance if it is a hospital bill, and only then make an offer for what remains.
What this means
Negotiating a medical bill means asking the provider to accept less than the amount billed, or to take it on terms you can manage. It is a request. We found no right to a discount and no typical discount, so we do not quote one. Dollar For’s sample call script and sample settlement letter show how to ask questions about the debt, make a settlement or payment-plan offer, and put an offer in writing. We found no source that says what persuades a billing office.
If a denial created the bill, negotiating does not replace the appeal. An agreement to pay a bill your plan may owe can mean paying twice. Work out first whether the plan should pay.
What to do
- Make sure the amount is yours (your step). Match the bill to your Explanation of Benefits using a bill is not an Explanation of Benefits. Ask for an itemized bill with the itemized bill request, and look for coding and billing errors.
- Apply for hospital financial assistance first, if the bill is from a hospital. It can reduce or cancel the bill, so try it before you bargain. See hospital financial assistance.
- Decide your numbers before you call. Know what you could pay in one payment, what you could pay each month, and what you have already paid. Do not offer more than you can pay.
- Look at price information. FAIR Health Consumer, a nonprofit, offers a cost lookup that shows estimated charges and in-network prices for a procedure in your area. Use it as a talking point. It is an estimate, not what your hospital has to accept.
- Call the billing office and ask for a supervisor or financial counselor (your step). Dollar For’s call script has you ask questions first and make your ask second. Say what you can pay and ask what discount they can give for a single payment.
- Put your offer in writing. The bill negotiation offer is for putting an amount in writing. Dollar For’s sample settlement letter offers a lump sum and advises you to expect a counter-offer. Be ready to go back and forth once or twice.
- Get the agreement in writing before you pay. It should name the amount, say the account is settled or paid in full, and say what happens to any collection or credit report entry. Pay in a way that leaves a record, and keep the receipt.
- If the bill is already in collections, use the questions in medical debt in collections first.
Paying a person to negotiate is possible, and Dollar For lists it as an option. See paying for help for what to ask before you do.
What the billing office may say, and what to say back
“That is the price. We do not negotiate.” I understand. Is there a financial counselor or a supervisor who can review a hardship request? I can pay a lump sum if the balance can be reduced.
“We can only offer a payment plan.” I would like to see the plan terms in writing, including any interest or fees. I would also like to ask for a reduction first.
“We cannot discuss it while your insurance appeal is open.” Please hold the account in writing while the appeal is open. I will call back when I have the result.
What no rule here settles
Debt collection and credit reporting are governed by federal and state law, and this page does not set out those rules. Do not rely on this page for them.
Check current rules before you agree to anything. The Consumer Financial Protection Bureau explains federal consumer finance rules, and a legal aid office can confirm what applies in your state.
Watch for
- A “paid in full” that is not written down. A phone promise is easy to lose. Ask for the letter.
- Paying a disputed amount. If you pay and later win the appeal, ask in writing how the refund will be handled.
- Pressure to pay today. Ask for the offer in writing and take a day.
- Fees to a middleman. Ask any company that negotiates for you how it is paid, who does the work and what it keeps. See paying for help.
What next
- Payment plans and medical credit cards: what to ask if you cannot pay in one payment.
- Medical debt in collections: what changes once an account moves.
- Get a hospital bill reduced: all the pages on this topic.