How to negotiate a medical bill

Does negotiating a medical bill work?

Often, yes. In a national survey, many insured adults who challenged a bill they thought was wrong got it reduced or removed. Their share was 38% (Commonwealth Fund, Gupta et al., April 18 to July 31, 2023). Another survey asked people who negotiated with the billing office whether they got a lower price. The share who did is 61.8% (Duffy, Frasco and Trish, August to October 2023) One 2023 survey of US adults; these are outcomes people reported, not audited results.

Results are not guaranteed, and a hospital does not have to agree to an offer. But a call costs you nothing, and the order below gives you the strongest position.

The order to follow

1. Get the itemized bill. Ask for every charge, line by line, and compare it with the explanation of benefits from your insurer if you have one. Our guide to the itemized medical bill shows what to look for.
2. Fix mistakes first. Duplicate charges, services you did not get and charges your plan should have covered come off before any negotiation. In the same survey, most people who called about a mistake got it corrected Source 22.
3. Ask for financial assistance. At a nonprofit hospital, a patient who qualifies may not be charged more than the amounts generally billed to insured patients for emergency or medically necessary care Source 33. Apply before you negotiate the rest Source 44. See our guide to charity care.
4. Ask about a discount. Ask whether there is a self-pay discount or a discount for paying the balance at once.
5. Make an offer you can keep. Offer a lump sum you can actually pay, or a monthly payment plan that fits your budget. Ask whether the plan charges interest.
6. Get it in writing before you pay. The letter or email should give the new balance, the payment terms and the account number.

What to say when you call

Have the bill, the itemized bill and a pen ready. Ask for the name of the person you speak with. Short, calm sentences work best:

"I'm calling about account [number]. I've reviewed the itemized bill and I have some questions about these charges."

"I can't pay this balance. Can you send me your financial assistance application?"

"Is there a discount if I pay part of the balance today?"

"I can pay [amount] now as payment in full. Can you put that in writing?"

"I can pay [amount] a month. Can we set up a plan with no interest?"

If the first person cannot help, ask for a supervisor or a patient financial counselor.

What percentage should you offer?

There is no standard percentage. What a provider accepts depends on the provider, how old the bill is and whether you qualify for financial assistance. Offer an amount you can really pay, say why you cannot pay the full balance, and ask what the lowest amount is that they can accept.

If you have insurance

• Check that the provider billed your plan, and that the plan processed the claim correctly. If the plan refused to pay, you can ask it for an appeal.
• The No Surprises Act protects people with most kinds of health insurance from most surprise out-of-network bills for emergency care, for care connected to a visit to an in-network hospital or surgery center, and for air ambulance services Source 55. Ground ambulance is not covered by the federal law, though some states protect you Source 66.
• For questions about a surprise bill, call the federal No Surprises help line at 1-800-985-3059 Source 55.

If you don't have insurance

• Ask for a good faith estimate before care. Uninsured and self-pay patients usually have the right to one when they ask for it, or when they schedule care far enough ahead. The minimum notice is 3 business days (CMS, published October 5, 2026).
• Dispute a bill far above the estimate. You can start a patient-provider dispute when the bill is higher than your good faith estimate by at least $400 (CMS, published October 2, 2026). The time you have, counted from the first bill, is 120 days (CMS, published October 2, 2026). The fee is $25 (CMS, published October 2, 2026). It comes off what you owe if the reviewer decides for you.
• While the dispute is open, the provider may not send the bill to collections, add late fees or retaliate. If you settle, the provider must take off at least half the dispute fee Source 77. That comes to $12.50 (CMS, published October 2, 2026).

Negotiating with a debt collector

If the bill is already with a collection agency, ask for the details of the debt first. You can dispute it in writing. The time you have, counted from its notice, is 30 days (CFPB, published January 29, 2024). Once you dispute, it must pause collecting the disputed amount until it answers Source 88.

Be careful with old debts. In some states, a small payment or a written promise to pay can restart the time limit for a lawsuit Source 99. Before you pay anything on an old debt, check that limit or ask a legal aid office. Our guide on the statute of limitations explains it.

Any settlement with a collector should be in writing before you pay, and should say that the amount settles the debt in full.

Keep a record

Write down the date, the name of each person you spoke with and what they said. Keep copies of every letter, email and payment. If a promise is not in writing, ask for it in writing.