Leif Adamec Rydenfalk
The hospital bill is too high
A medical bill is a first offer. Many contain errors, many hospitals have to discount or forgive bills for people under an income line, and a bill that goes unanswered is the one that ends up in collections. The order you do things in matters.
This page covers the US. In Sweden the patient fee ceiling (högkostnadsskydd) caps what you pay in a year, and complaints go to the region's patient board. This is what I'd do, in order. I'm not a lawyer, and if you'd rather not deal with it, send it to me.
Ask for the itemized bill
The first bill is a summary. Call the billing office and ask, in writing, for the itemized bill with the billing codes (CPT and revenue codes) and the dates of each charge. Ask your insurer for the explanation of benefits for the same visit. Until you have both, don't pay and don't agree to a payment plan.
Tell the billing office the bill is under review. Most hospitals hold collections while an account is disputed or under review, but only if they know.
Look for the usual errors
- Charges for things that didn't happen. A test that was cancelled, a medicine you brought yourself, a day you were already discharged.
- The same thing twice. Duplicate lines with the same code and date.
- A visit coded higher than it was. A short check billed as a complex visit is one of the most common overcharges.
- Insurance applied wrong. The explanation of benefits says you owe less than the hospital bills you for. You owe the smaller number.
The rules on your side
| Nonprofit hospitals | Most US hospitals are nonprofit, and federal tax rules (IRS 501(r)) make them publish a financial assistance policy and take applications for at least 240 days after the first bill after discharge. Below the income line in their policy, the bill is cut or wiped, even after it went to collections. |
|---|---|
| Emergency care out of network | The No Surprises Act stops most surprise bills: emergency care, and out-of-network doctors at an in-network hospital, can only charge your in-network share. Ground ambulances are not covered by it. |
| No insurance | You're entitled to a good faith estimate before planned care. If the bill comes in $400 or more above it, you can start a federal dispute within 120 days of the bill. |
| Credit reports | The three big credit bureaus don't list medical debt under $500, wait a year before listing any medical debt, and remove it once it's paid. |
Then negotiate what's left
Once the errors are out and assistance is applied, ask for a discount on the rest. Offering to pay a lump sum now often gets 20 to 50 percent off. If you need time, ask for an interest-free plan in writing. Get every agreement in writing before you pay anything.
Or hand it to me
Send me the bill and the insurer's explanation of benefits. I go through it line by line, write the dispute and the assistance application, and handle the back and forth with the billing office until there's a final number. You get a fixed price before I start.
