Tips on Negotiating Your ER Bill and Getting the Most from Your Medical Insurance

With medical costs averaging $2,607 per day across the nation, it isn’t surprising that, in 2021, 50% of Americans carried medical debt. But what might be surprising is that nearly over 61% of patients see their debt starting from an ER admission.

Luckily, with the right strategies, it is possible to lower these costs, make the most out of your insurance cover, and stay out of debt. But first things first: negotiating your bill is possible – and even recommended. Learn how below. 

Double-Check Your Bill

If you are having trouble understanding your medical bills, you are not alone. For millions of Americans, navigating the terms, balances, and procedures of settling a medical bill is a significant challenge, which often leads to the outstanding debt.

But, even more importantly, it is in this confusion that errors and inaccuracies thrive. And, according to a 2016 report, nearly 80% of medical bills contain one or more mistakes. 

So, the first step to reducing your medical costs is to ask for an itemized copy of your bill.

Here you can highlight errors such as incorrect patient names, insurance information, and procedures codes. Removing the most common overcharges (upcoding, PPO network, and “surprise” billing) can help you save 15-80% on your medical costs. 

Review Your Insurance Cover and EOB – And Call Your Provider

If you have medical insurance cover, your health care provider will bill your insurer to be reimbursed for your ER treatments. After this step, your insurance provider will send you an EOB – or Explanation of Benefits statement.

In this document, you will find vital information, including:

• The explanation of your medical bill and costs involved
• The costs that will be covered by the insurance
• The medical expenses that are not covered by your insurance plan and you’ll be responsible for.

One of the best ways of making the most of your insurance coverage is to compare this breakdown to the medical bill. Undoubtedly, reviewing your insurance terms can be a time- and effort-consuming task but it’s essential to verify that your claims were accepted.

If you have noticed a wrongful claim denial or a bill for a procedure that should be covered, make sure to contact the hospital’s billing department. They will be able to correct the error and resubmit a claim. Alternatively, contact your insurance provider to appeal a denial.

Compare Prices and Payment Plans – Or Offer a Lump Sum Payment

Once you have corrected any errors on your bill or coverage, you will need to deal with the out-of-pocket expenses of your ER treatments. The next step will be to compare the prices for each treatment on your medical bill against the average cost for the same treatment in your zip code or state. 

If you have found that you have been charged an unfair price, consider using this knowledge during the negotiation process.

In any case, if you cannot afford to pay the entire bill right away, consider asking for a payment plan that works for you. Hospitals’ billing departments often have discounts and interest-free plans available for patients. Just ask!

• Pro Tip: it is in the interest of the billing department to close any outstanding balances you might have, and they will offer significant discounts for lump-sum payments. For example, if you owe $2,500, consider asking whether they would accept $2,000 (or less) if paid in total immediately.

Understand The Ins and Outs of Out of Network Billing

For years, patients with a health insurance policy covering specific networks or providers were charged significant bills if they were treated by out-of-network providers or in out-of-network facilities.

In the case of ER treatments, almost certainly you won’t be treated by your regular doctor, even if you are in an in-network facility. 

This means that the difference between what you are charged (usually a higher price) and what your insurance plan covers could become steep out-of-pocket expenses. This is also known as “balance” or “surprise” billing. 

However, the 2022 No Surprises Act introduced new rules that protect patients against these charges for most essential medical care received out-of-network. This means that you won’t need to fill the cost gap between your insurance coverage and the out-of-network bills. 

If you notice any of these charges, don’t think twice about bringing up the issue with the hospital patient advocate or an independent medical billing advocate.

Consult a Patient or Medical Billing Advocate – and Check if You Qualify For Forgiveness

When negotiating your ER or medical bills, you won’t need to undergo this process by yourself. There are two main points of contact you can leverage:

• Hospital patient advocates

A patient advocate is a neutral staff member trained to handle billing issues and complaints. They can help you obtain copies of your bills and medical records, as well as liaise between the hospital billing department and your insurance provider. Here is also where you’ll find information about available discounts, payment plans, and financial help. 

• Medical billing advocates

As medical bills errors, discrepancies, and overcharges become increasingly common, many patients resort to hiring an external medical billing advocate. These experts will review your bill and dispute errors.

If you are still unable to pay the bill – and you can prove the status of your finances – you might also be able to apply for Medicaid or other financial assistance programs. Alternatively, consider asking for medical forgiveness. 

Don’t Forget: Politeness Can Get You Far

No matter how far in advance you have started building your medical emergency fund, an ER bill can throw your household’s finances off balance. That is why negotiating your bill is vital. At the same time, the way you interact with the hospital staff will make a difference in the leverage you’ll be able to count on when negotiating.

Make sure to keep notes of your conversations with doctors, write down the contact details of the people you speak with, and keep your conversations factual, direct, and polite.

While dealing with steep medical charges can be stressful, you’ll be able to secure more benefits when maintaining a firm but calm tone.