Get an Itemized Bill
Call the billing department and request a UB-04 (hospital) or HCFA 1500 (physician) itemized bill. This is different from the summary statement you receive in the mail.
What to look for:
- Individual CPT/HCPCS codes for every procedure and service
- Duplicate charges (same code billed twice)
- Unbundled charges (services that should be one charge split into many)
- Charges for services you did not receive
- Upcoding (a more expensive code than the service actually provided)
Tip: Under federal law, hospitals must provide itemized bills within 30 days of a written request.
Look Up Each CPT Code
Search each CPT code from your itemized bill on MedicalCosts.info to find out what Medicare pays for each service.
Common CPT codes on ER bills:
Compare to Medicare Rate
The Medicare rate is the national benchmark price the federal government sets for each procedure. It is the single most important number in your negotiation.
You can use our Bill Checker tool to instantly compare your bill to Medicare rates.
Know the "Fair Price" Range
Commercial insurance companies typically negotiate rates between 150% and 250% of the Medicare rate. This is your "fair price" benchmark.
| Price Level | % of Medicare | Assessment |
|---|---|---|
| Below 150% | Under 1.5x | Excellent price |
| 150% - 200% | 1.5x - 2x | Good / Fair |
| 200% - 250% | 2x - 2.5x | Normal range |
| 250% - 400% | 2.5x - 4x | Above average — negotiate |
| Above 400% | 4x+ | Very high — strongly negotiate |
Call the Billing Department
Call the hospital or provider's billing department (not the collections number). Be polite, persistent, and come prepared with your data.
Sample script:
"Hello, I am calling about my bill for [procedure]. I have been billed [amount]. I have researched the Medicare rate for this procedure, which is [Medicare rate], and commercial insurance companies typically pay between [fair range]. I would like to discuss a reduction to a fair and customary rate."
Key phrases: "fair and customary rate," "Medicare-based pricing," "financial hardship," "prompt payment discount"
Request a Financial Hardship Discount
Most hospitals are required to have financial assistance policies (especially non-profit hospitals). Common discounts:
- Charity care: Free or reduced care for low-income patients (many hospitals require income below 200-400% of federal poverty level)
- Prompt pay discount: 10-30% off for paying within 30 days
- Uninsured discount: 20-60% off for self-pay patients
- General hardship: 20-40% reduction based on demonstrated inability to pay
Tip: Non-profit hospitals receiving federal tax exemptions are legally required to have financial assistance programs under IRS Section 501(r).
Negotiate a Payment Plan
If you cannot pay the (reduced) bill in full, most hospitals offer interest-free payment plans. Key points:
- Most hospitals will agree to 12-24 month payment plans
- Always get the agreement in writing
- Confirm the plan is interest-free (most hospital plans are)
- Set up automatic payments to avoid missing deadlines
- Ask if the total can be further reduced for committing to a payment schedule
If Denied, Escalate
If the billing department will not negotiate, you have several escalation options:
- Ask to speak with a supervisor or the patient financial services director
- File a formal dispute in writing (use our letter generator)
- File a complaint with your state insurance department (links below)
- Contact your state attorney general's consumer protection division
- Hire a medical billing advocate (they typically charge 25-35% of the savings)
- For bills over $10,000: consult with a healthcare attorney
Sample Negotiation Letter
Use our interactive letter generator to create a personalized version, or use this template:
State Insurance Department Links
If your provider or insurer will not resolve a billing dispute, file a complaint with your state insurance department: