How to Negotiate a Medical Bill (and Ask for Help Paying)

Written by Aptiva Health Editorial Team · Reviewed by Crystal Brake, RCM Director and Taylor Sorrels, Esq. · Editorial & review standards · How we research

A medical bill is often not a fixed number. Many providers will lower a bill, spread it out over time, or forgive part of it. Some hospitals must offer help to patients who qualify. But you usually have to ask.

This guide gives you what to say on the phone, how to ask for a cash price, how payment plans work, and the federal rules for hospital financial assistance (also called charity care). It is part of the Coverage & Appeals Center.

Before you call

1. Make sure the bill is right. Ask for an itemized bill and check it. See how to get an itemized bill.
2. If you have insurance, check your EOB. Your Explanation of Benefits (EOB) shows what the plan paid and what you may owe. If the plan denied the claim, you may be able to appeal. Start at the Coverage & Appeals Center or use the denial decoder.
3. Check for a surprise bill. If you got out-of-network charges for emergency care or at an in-network hospital, federal law may protect you. See balance billing.
4. If you didn’t use insurance, find your good faith estimate. If the bill is at least $400 over the estimate, you may be able to dispute it (CMS: Dispute a medical bill). See disputing a bill over your estimate.
5. Know what you can pay. Decide on a monthly amount, or a one-time amount, that fits your budget.
6. Have your papers ready. Account number, the bill, the EOB, and a pen to take notes.

What to say on the phone

Be polite and direct. Write down the date, the name of each person, and what they said.

To open the call:

To ask for a discount:

To ask for financial assistance:

To ask for a payment plan:

To ask for a hold:

To get it in writing:

If the answer is no:

Ask for the cash or self-pay price

• Hospitals publish prices. Hospitals must post a file online that lists their standard charges, including the discounted cash price for each item and service (45 CFR 180.50). It must be free to view, with no account or personal information needed (45 CFR 180.50).
• Ask for an estimate first. If you don’t use insurance, providers must give you a good faith estimate when you schedule at least 3 business days ahead, or when you ask (CMS: Rights when not using insurance).
• Insured? Ask before you choose cash. Paying cash instead of using insurance may mean the payment does not count toward your deductible.

Payment plans

No federal rule we found requires most providers to offer a payment plan. Many do. Before you agree to one, ask:

• What is the monthly amount, and for how many months?
• Is there interest or a fee?
• What happens if I miss a payment?
• Will the account stay out of collections while I pay?
• Can I get the plan in writing?

Only agree to a payment you can keep up with.

Hospital financial assistance (charity care)

Many hospitals forgive all or part of a bill for patients who qualify. Some must.

Which hospitals must offer it

Federal tax law sets rules for nonprofit hospitals that are tax-exempt under section 501(c)(3). These rules are in section 501(r) of the tax code. They cover four areas: a community health needs assessment, a financial assistance policy, limits on charges, and billing and collections (IRS: 501(r)).

These rules don’t apply to for-profit hospitals or to most doctors’ offices.

To find out whether a hospital is nonprofit, ask the billing office.

The financial assistance policy

A 501(r) hospital must have a written financial assistance policy (FAP). It must explain (IRS: 501(r)(4)):

• Who is eligible, and whether help means free or discounted care.
• How the hospital figures out what it charges patients who qualify.
• How to apply.
• What collection actions the hospital may take if a bill isn’t paid.

The plain-language summary

The hospital must also have a plain-language summary of the policy: a short, clear statement that the hospital offers financial assistance (IRS: 501(r)(4)).

• The hospital must offer you a paper copy of the summary when you check in or when you leave (IRS).
• The policy, the application and the summary must be on the hospital’s website, free to view and print (IRS).
• Free paper copies must be available by mail and in public places at the hospital (IRS).
• The documents must be translated for large groups in the community who speak another language (IRS).

Limits on what you can be charged

If you qualify for financial assistance, a 501(r) hospital (IRS: 501(r)(5)):

• Can’t charge you more for emergency or other medically necessary care than the amounts generally billed (AGB) to people who have insurance.
• Must charge you less than its full “gross charges” for other care covered by the policy.

Limits on collections

Federal rules call serious collection steps extraordinary collection actions (ECAs). They include (IRS: 501(r)(6)):

• Selling your debt to another company.
• Reporting you to credit bureaus.
• Delaying or denying needed care, or asking for payment first, because of an old unpaid bill.
• Legal steps, such as a lawsuit, a lien on your property, taking money from your bank account, or garnishing your wages.

Before a 501(r) hospital takes these steps, it must make reasonable efforts to find out whether you qualify for help (IRS: 501(r)(6)):

All of these are from the IRS 501(r)(6) page (IRS).

Apply early. Ask for the policy and application on the first call, even if you are not sure you qualify.

Kentucky and Indiana

• Kentucky: We did not find a Kentucky statute or agency page that sets charity care rules for patients. The Kentucky laws we checked fund hospitals that serve low-income patients; they don’t set patient rights.
• Indiana: Ask the hospital for its financial assistance policy, and check with your plan or the Indiana Department of Insurance about any Indiana rules on hospital bills and payment plans. –

Your sample letter

[Your name]
[Your address] · [Your phone] · [Your email]

[Date]

[Hospital or provider name] — Billing Office / Financial Assistance
[Address or fax from your bill]

RE: Request for financial assistance and payment options
Patient name: [Name] · Date of birth: [Date]
Account number: [Number]
Date(s) of service: [Date or dates]
Amount billed: $[Amount]

To the Billing Office:

I received a bill for $[amount] for the care listed above. I want to resolve it, but I can't pay the full amount.

Please send me:
- Your financial assistance policy, the application, and the plain-language summary
- Your self-pay or prompt-pay discount, if any
- Your payment plan options, including any interest or fees

[If you are applying now:] My completed financial assistance application is enclosed, with [proof of income / other documents].

[If you checked the bill:] I reviewed the itemized bill. I believe these charges are wrong: [line, date, code, reason]. Please correct them.

Please hold my account while you review this request, and do not send it to collections. Please confirm in writing.

I can pay $[amount] now [or $[amount] a month].

You can reach me at [phone] or [email]. Thank you.

Sincerely,
[Signature]
[Printed name]

Common mistakes

• Paying with a credit card before you ask. Once the bill is on a credit card, the hospital’s financial assistance and payment plan may no longer help.
• Not getting the deal in writing. A phone promise is hard to prove later.
• Agreeing to a payment you can’t keep. Missing payments can undo the deal.
• Not applying for assistance because you think you earn too much. Each hospital sets its own limits. Ask for the policy.
• Ignoring letters. Call back, even if you can’t pay yet. Ask for a hold.

Need help with an Aptiva bill?

If you are an Aptiva patient and you’re worried about a bill, call our billing team before it is due.

For a denied claim, start at the Coverage & Appeals Center or use the appeal letter builder.