Before You Pay Your HealthCare Bill
How to Check, Ask, and Negotiate
Not long ago, my nephew came to me after having surgery on his foot from a sports injury.
“Aunt Bonnie, can you look at this? Does it seem right to you?”
He had insurance. He’d gone to an in-network hospital. We reviewed the information from the hospital, doctor, and insurance to verify that everything had been paid correctly. After validating that everything looked in order, the balance was still really high.
I walked him through some of his options, things he didn’t even know were available to him. Working with the billing office at the hospital and the provider, he ultimately qualified for a lump sum payment that saved him thousands of dollars.
No tricks, no loopholes. This was just about knowledge. Knowing what questions to ask and who to ask them to.
That experience reminded me that not everything has to feel like a fight or a challenge. Sometimes, it’s about knowing options and starting the conversation.
(And if there’s any way for me to position myself as the favorite Aunt, I’m going to do it. The competition is fierce in a large family.)
And since I can never resist turning a real-life story into a teachable moment, let’s talk about what you can do before the bill arrives and what to do after it arrives.
Being Proactive vs. Reactive
Before we discuss what to do after you receive a bill, I want to address some things that may help you avoid a surprise. Sometimes we anticipate the care that we will receive.
For example, I know that every year, I will have a preventative visit with my Primary Care Physician, a Mammogram, and quarterly neurology visits. I may have some other visits scheduled, but no planned surgeries or other procedures.🤞
Most of these are considered “preventative” and should be covered at 100%.
My husband, on the other hand (who is a hockey fanatic both playing and watching), is probably going to need that left knee surgery after years of putting it off.
So, we begin shopping for surgeons and in-network hospitals. We also decided to increase the amount we’re putting into our Health Savings Account (HSA) to help cover the deductible that we will need to meet.
Cash Pay vs Insurance
One thing many people don’t realize is that using insurance isn’t always the most cost-effective option, and there are alternatives.
If you have a high deductible or if what you are planning will contribute to your deductible (such as specific imaging or lab tests), ask your provider.
“What is your self-pay or cash rate if I don’t use insurance?
Understanding the cash price before scheduling care can save hundreds, and provides a baseline if you ever need to negotiate later. 🤓
💡You can look this up too. Many hospitals list their self-pay prices on price transparency tools or websites. Tools are listed later in this blog, which could give an idea of what the costs are if you want to review yourself.
Obtaining information directly from the provider's office is likely the most informative and complete (may also be defensible in court; however, we hope that no one has to do that).
On your EOB, if it shows “applied to the deductible” and you still have a balance, it’s worth making a phone call to the insurance company to ask why. It may be something that you shouldn’t have been billed for.
What doesn’t apply to the deductible? These items do not apply to the deductible (typically).
Annual wellness exams/physicals
Screenings: cholesterol, diabetes, blood pressure, cancer (mammogram, colonoscopy, Pap test, lung cancer screening)
Vaccinations: flu shot, shingles, COVID-19, Tdap, etc.
Prenatal and well-baby visits
Contraceptives and certain women’s health services
Once you’ve compared those options, there are a few other steps that make the biggest difference before you even walk into an appointment.
📝 If you need a refresher on cost sharing, that is in the blog “Copays, Coinsurance, Deductibles, Oh My!”
Tips for being proactive
Know your plan and what is covered. Use your benefit document or your insurance website.
How much is the deductible?
What is the co-pay or other expected cost-sharing amount (coinsurance)?
What preventative care is covered?
Is the doctor and facility I’m going to in-network for my insurance?
Ask the provider office upfront.
What if I don’t have insurance?
You still have options.
Many hospitals and clinics offer self-pay discounts and financial assistance based on income, even for patients without insurance. Ask for the “financial assistance” or “charity care” application—nonprofit hospitals are required by law to have one.
If your income is below or near the federal poverty line, you may qualify for significant reductions or even complete forgiveness of your bill.
You can check the current poverty level guidelines at healthcare.gov.
And always ask if there’s a cash or prompt-pay rate before services are done. It can make a big difference.
Healthcare without insurance can feel intimidating, but you still have more leverage and legal protections than you might think.
Of course, even the best planning can’t prevent every surprise. Because let’s face it, some medical needs don’t RSVP before they arrive.
Ok, but what if I couldn’t be proactive?
So being proactive and able to plan is great when you can. However, the reality is that for many of us, surprise bills and significant expenses arise because we couldn’t plan.
Start by checking what You Actually Owe
It’s not always about how much you make or what you can afford.
Sometimes, it’s about whether the bill is even correct, and what you can do if it’s not.
Compare your bill/statement with your Explanation of Benefits (EOB). That is the “This is not a bill” document from your insurance.
What your provider charged.
What your insurance paid.
What adjustments were made (like network discounts)?
What amount is left?
📝Remember to get an itemized copy of the bill, statement, or get one from the hospital or provider portal that has the details (e.g., procedure, diagnosis, etc.).
💡 Make sure your insurance actually processed the claim. A key thing to look for is whether a discount was actually taken if you went to an in-network provider or hospital. That may indicate the claim hasn’t been processed yet.
Look for any duplicate charges. It happens all the time: labs, scans, and facility fees can be double-entered.
Look for other errors. Do the procedures, tests, and labs look like what was done?
Once you’ve reviewed your EOB and confirmed what’s been paid (and what hasn’t), you’ll have a clearer picture of your actual balance.
✍️ If you need a quick refresher on how to decode an EOB and check for issues, check out my earlier post, “This Is Not a Bill?! Well, It Sure Looks Like One,” which goes into detail on reviewing an EOB with the provider bill.
Compare the billed amounts to your plan
Have I met my deductible yet?
Is this in-network or out-of-network?
Does this service apply to my copay or deductible?
💡If you are not sure, your plan’s member portal or benefits line can tell you what you “should” owe for that visit.
Once you’ve confirmed what’s accurate, you’re in a stronger position to ask questions or request adjustments. Knowledge gives you leverage.
🚑 What If You Didn’t Have a Choice?
Sometimes you don’t get to shop around.
If you were taken by ambulance, had an emergency surgery, or went to the nearest hospital because you needed care fast, and you probably weren’t thinking about networks, and that’s okay.
In those cases, you still have rights:
The No Surprises Act protects you from many out-of-network charges in emergencies or when you’re treated by an out-of-network provider at an in-network facility (like an anesthesiologist).
Contact your insurance company and request that they review the claim under the No Surprises Act if it was billed as an out-of-network service.
Ask the provider’s billing office if they can reprocess the claim as an emergency or “in-network exception.”
If you still get a large out-of-network balance bill, you can file a formal dispute. Your insurance company is required to inform you of the details.
📝See blog on “How to appeal a denied claim” for additional information.
💡 Tip: Even when the law doesn’t apply, many hospitals will still honor in-network rates for emergency care once you ask. It never hurts to call and explain the situation.
Once you’ve confirmed what the bill should (and shouldn’t)include, the next step is determining how to handle the remaining balance.
💸The Remaining Balance (for the surprises and the planned)
Ask for Financial Help (Yes, Really)
Even if you don’t think you’d qualify, many hospitals and clinics have financial assistance programs. Even if you don’t think you’d qualify, it’s always worth asking. Many hospitals and clinics offer financial assistance programs, often referred to as charity care or hardship discounts.
Here’s what to know:
It’s not just for the uninsured. Even if you have insurance, you may still qualify based on income, family size, or special circumstances.
You’ll usually need to show basic financial info (e.g., recent pay stubs, W-2s, or your most recent tax return).
You can request an application anytime. It’s your right as a patient; ask for the “financial assistance policy” or “charity care program.”
💡 Approval can take time, so ask if the billing team can pause collections while your application is under review.
Nonprofit hospitals are required by law to offer charity care or discounted rates based on patients' ability to pay.
You can apply even after you’ve received the bill.
Prompt pay or lump sum payments are offered for a discount to settle the amount immediately.
You can check the current poverty level guidelines at healthcare.gov.
Many people are surprised to learn that they qualify for partial or full assistance, which can sometimes reduce a bill by thousands of dollars.
Some people may not qualify, or don’t want to apply for financial assistance. There are other options available; that’s where negotiations come in, the next lever to pull before giving up.
Negotiate, it’s not just for used cars 🚗
If you are unable to pay in full, please inquire about alternative payment options.
This may feel awkward. I once heard someone say, “I don’t want to ask because what if it’s taking away from someone?” But that isn’t how it works.
Most provider offices expect these kinds of conversations.
Here are a few things worth asking about; you don’t need to be an expert in health care for this.
Prompt-Pay or Lump-Sum Discounts
Many hospitals and clinics will reduce your bill if you can pay a portion of it upfront.Ask: “Do you offer a discount if I pay the balance in full or make a large payment today?”
Typical savings: 10–30%
Interest-Free Payment Plans
Instead of putting it on a credit card, ask the provider to set up a plan directly with them.Ask: “Can I set up a monthly payment plan with no interest or fees?”
Tip: Even large hospital systems usually offer 6–12 month options.
Financial Assistance or Income-Based Discounts
Even with insurance, you might qualify for help — especially if your income falls below a certain threshold.Ask: “Do you have a financial assistance or hardship program I can apply for?”
Tip: Nonprofit hospitals are required by law to offer this.
Combine and Conquer
Sometimes you can combine these methods. For example, a prompt-pay discount is applied to an income-based reduction, and then a payment plan is established for the remaining amount.
Don’t assume you have to choose only one option.
A few things to keep in mind
Be polite but also direct.
Come into the conversation informed and prepared whenever possible (have the date of the procedure or service, let them know what you’ve reviewed, etc.)
Document who you speak with. Write down names, dates, and what was discussed. Specifically, if a promise or arrangement was made.
Follow up in writing. If there was an agreement for a discount or payment plan, request confirmation before making the payment.
Ask early. Once a bill goes to collections, it becomes more challenging to negotiate, and discounts or flexibility may not be available.
Get Help from an Advocate
Nonprofits like the Patient Advocate Foundation can help negotiate bills.
State consumer protection offices often have a healthcare advocate/representative.
If you’re truly overwhelmed, talk with a financial counselor at your hospital. They can often pause collections while reviewing your case.
Other Resources
If you’re self-pay, uninsured, or just want to double-check a bill, here are a few places to look up prices before you schedule care:
FAIR Health Consumer – a free national tool where you can search common procedures and see typical price ranges in your ZIP code
👉 https://www.fairhealthconsumer.org
Hospital price estimator tools – most hospitals now offer online estimators for imaging, laboratory services, outpatient procedures, or even surgeries.
👉 Try searching “[hospital name] + price estimator” or “shoppable services”
Example: Intermountain Health Care https://intermountainhealthcare.org/for-patients/hospital-price-estimatesState or government price sites – some states publish cost comparison tools or hospital dashboards.
👉 Example: Utah HealthCost Compare https://healthcost.utah.govSimilarly, many states now have All-Payer Claims Databases (APCDs) — public sites that combine paid claim data from multiple insurers. They’re designed to show what different hospitals or clinics actually get paid for common services. Some of these sites are pretty technical, but others, like Colorado’s, have easy “shop for care” tools where you can compare prices by facility.
👉 https://www.apcdcouncil.org/state/map
Companies that help patients compare or save money – some offer free online tools, others offer personal support.
Under the No Surprises Act, a “Good Faith Estimate” is required by law, and patients can ask for a detailed estimate of expected charges. Find more information on the Center for Medicare and Medicaid Website here: https://www.cms.gov/medical-bill-rights/help/guides/good-faith-estimate
💡You don’t need to know medical codes to use these tools. You can search things like ‘MRI,’ ‘strep test,’ or ‘colonoscopy,’ and it will find it.
Wrapping Up
Sometimes, it can feel like the healthcare system was designed by a committee of people who never met a patient. Between the acronyms, codes, and mysterious other hoops, it’s easy to feel like you’re in a game and don’t have the rulebook.
But the truth is, you are not helpless or powerless. Every call, every question, every “Wait, can you explain this?” adds up. When you encounter an error, ask for help; each step makes a difference and can lead to real savings.
And I cannot promise you that you will enjoy dealing with insurance and medical bills; to me, it always feels a lot better knowing you understand a little bit better.
Thank you for reading,
Bonnie
📚 Missed the earlier posts in this series?
Catch up here: https://coviewconsulting.substack.com/
Why I Started CoView: Navigating Both Sides of Healthcare
Speaking the Same Language in Healthcare
Meet the Players: Patient, Provider, Payer
Cracking the Code
Your Claims Post Visit Adventure
This is Not A Bill? Reading your EOB
Who Pays For What? Part 1: Medicare & Medicaid
Choose Your Own Adventure: Commercial Insurance Explained
Copay, Coinsurance, Deductible Oh My!
No Soup For You! Claim Denials Explained
How to Appeal A Denied Claim
Understanding Health Plans
What’s Next: Why Doesn’t My Doctor Know What I Will Owe?
Okay, I’ve been telling you not to be afraid to call your provider's office to ask for help, but there’s one question that’s so difficult for a doctor to answer: “What will I owe?” We’re going to go into that next time, why providers and doctors' recommendations are not always in line with what the insurance pays, and why your doctor doesn’t know.
💡 If this post helped clarify your coverage chaos, share it with a friend or colleague! And if you have questions or want to see a specific topic covered, drop me a line. I’d love to hear from you.
Note from the Author: This blog is for educational purposes only and reflects my experience. This is not intended as legal, financial, or medical advice, nor is it a preparation for any medical coding exam. Always confirm details with your insurance company, healthcare provider, or HR department. It’s designed to help cross-functional teams in the healthcare industry work together more effectively, and to help you feel more confident advocating for yourself and your loved ones in your personal healthcare matters.
