Hospital bills are open to negotiation. Here’s how.

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It was shaping up to be an expensive year for me: My then-2-year-old had already had an emergency room visit. And there was the fact that I was going to have another baby. Just how expensive would depend on a few factors, including the medical care itself (would my birth be routine or complex? Would there be another ER visit?) and the amount of money that my health care providers were requesting for it (a mystery that might be revealed after the fact—as you are probably very aware, it’s nearly impossible to get a clear sense of what you will owe before getting care).

I have been writing about state and federal health care policy for more than a decade, mostly for public radio. I knew from my work that doctors, hospitals, and laboratories typically accept vastly different prices for the exact same service, depending on what insurance provider is paying. Having private insurance in America means that you and your insurer might be spending 10 times as much for that colonoscopy or ACL surgery as someone on Medicare. Not to mention, cash prices are typically even lower (but patients are on the hook for the whole bill).

From my work, I also knew that researchers and health care advocates are always telling patients to negotiate because hospitals would rather collect something than sell the debt for pennies on the dollar to collections agencies.

So I decided to try it. Early in pregnancy, women often get blood tests to screen for a handful of genetic abnormalities. Natera is one of the largest genetic testing companies to offer the test. Doctors, hospitals, and lab companies can set absurdly high sticker prices as a starting point for negotiations with insurers. Natera charged my insurance company $3,900. Most of the time, the actual amount providers settle on with insurers is much lower than the initial cost. In this case, that figure was $684. My insurer paid $284. I was on the hook for the remaining $400.

A few weeks earlier, Natera had sent me an email offering me a cash rate of $250, meaning that if I paid the bill right then and there, that would be the entire total. I declined and let the company bill my insurance because I knew that the test was covered. I even called Natera and my insurance provider to ask the negotiated rate—but both refused to tell me. (Yes, they can do that, because they call those rates “trade secrets.”) So I rolled the dice and sent the bill to insurance.

My insurer paid more than the cash rate, and the company was still seeking another $400 from me. I was mad but not surprised. It just seemed so ridiculous that having insurance and paying monthly premiums somehow made this test more expensive. I psyched myself up to argue and dialed the customer service number on the back of the bill.

The first customer service representative said no discount. I asked to speak to his supervisor. After I spent a few minutes on hold, the supervisor came back and said, “I was able to approve the write-off.” It took less than 20 minutes.

I felt vindicated—and empowered. I was hooked. I decided, Let’s see how much I can save myself this year.

I followed the same steps. I called, said I couldn’t afford to pay the entire bill, and asked if I could get a discount if I paid a portion immediately. Each time, the first-line representative said no, suggesting something like, “If you can’t afford to pay it now, set up a payment plan or apply for financial assistance.” But I had learned from that first call to politely ask to speak to a supervisor to see if I could get an exception. Most of the time, they happily forwarded me, an annoying patient, on to the person in charge. I would repeat my request, and each time I got some discount.

I luckily had a very standard birth, a healthy baby, and a two-day hospital stay. Nonetheless, for both of our care, I still was on the hook for four figures total, from two different bills.

There was the bill for the OB-GYN who helped deliver my baby and the anesthesiologist who gave me my epidural.

The total bill for my medical care: $5,689
My insurance paid: $3,554
I owed: $887
I paid: $762 
I saved: $125 (14 percent)

Then there was the bill for my infant daughter’s care following her birth. (Yes, as soon as your baby is born, they start accruing their own medical bills.)

The hospital billed: $4,490
Insurance paid: $2,505
I owed: $612
I paid: $509
I saved: $103 (about 17 percent)

The remaining bill of the year was for my 2-year-old’s emergency room visit for a dislocated elbow. The entire visit was so fast my husband didn’t even have time to finish parking the car before we were discharged. The resident in the triage area reset my daughter’s elbow within minutes and we were headed out the door.

For those 15 minutes, the hospital charged: $2,795
I owed: $930

This bill seemed so high for what the visit was. I scrutinized it and noticed that the hospital had billed me for the same code twice. I challenged it with my insurer, who agreed. A year later, the bill is still being processed, but I’m on track to see a $200 reduction in the raw bill. This is before I call to negotiate a discount off that amount. But by reviewing the bill and asking about it, I will save $207 (about 20 percent).

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Sure, $125 here, $400 there might not seem like a lot. But it added up fast for my family of four. I should save $862 for my family’s medical care in 2025 from a handful of phone calls. If you feel awkward about asking for a discount, just remember: Your grandmother on Medicare might be paying five or 10 times less for the same blood work or MRI.

In a world where food, gas, and housing costs are all rising beyond our control and 4 in 10 adults have medical debt, this is one small way I feel as if I can exercise a little negotiating power. Ideally, insurers would be doing this on my behalf, but they have a perverse incentive. Federal rules allow them to keep 20 percent of the money they charge us (our health insurance premiums) for overhead and profit, while 80 percent must be spent paying out health care claims. Which means, weirdly, that if the amount they pay out in claims is higher, they can in turn charge us more—and pocket more.

That leaves it up to us, new parents or people recovering from surgery, many of whom don’t realize the prices are flexible. I can’t fix a system that makes basic care expensive and insurance coverage thin—that’s up to policymakers. But I can refuse to accept whatever number comes on the bottom of the bill.

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