How To Get Medical Bills Lowered After Insurance
Practical steps to lower medical bills after your EOB is processed. Includes appeal tips and negotiation scripts.
Most Insurance Issues Are Fixable
Appeals often succeed, and coordination errors are commonly fixable. Even after "final" processing, you still have options to reduce what you owe.
What You'll Need Before Starting
From Your Insurance
- Complete EOB (Explanation of Benefits)
- Summary of Benefits & Coverage (SBC)
- Member ID card with group numbers
- Any prior authorizations obtained
From Your Provider
- Original itemized bill
- Medical records for the visit
- Any statements since EOB issued
- Provider's billing department contact info
Compare Your EOB to Provider Bill
The EOB shows what insurance paid and what you owe. Your provider bill should match the patient responsibility exactly.
Key Numbers to Match
| Field | On EOB | On Provider Bill | What if Different? |
|---|---|---|---|
| Service Dates | 3/15/25 | 3/15/25 | Call both - wrong claim |
| Billed Amount | $8,500 | $8,500 | Should match |
| Insurance Paid | $6,400 | $6,400 | Should match |
| Patient Responsibility | $2,100 | $2,100 | This is what you negotiate |
Common Mismatches & What They Mean
- • Provider bill higher than EOB patient responsibility: Provider hasn't applied insurance payment yet
- • Provider bill shows different service codes: Insurance processed different codes than billed
- • Insurance shows "not covered" but provider says it should be: Coding error or prior auth issue
- • Multiple EOBs for one visit: Claims were split or reprocessed
Script for EOB/Bill Mismatch
"I'm comparing my EOB to your bill and the amounts don't match. My EOB from [Insurance] shows patient responsibility of $[amount] but your bill shows $[amount]. Can you help me understand the difference and ensure the insurance payment was applied correctly?"
Appeal Insurance Denials
Most Common Winnable Denials
- • "Not medically necessary" (needs doctor letter)
- • "Experimental/investigational" (needs literature)
- • "Not covered benefit" (check if miscoded)
- • Missing prior authorization (retroactive possible)
- • Out-of-network provider (check if emergency)
- • "Duplicate service" (needs records proving different)
- • Wrong diagnosis code on claim
- • Coordination of benefits errors
Internal Appeal Process (Step 1)
External Review Process (Step 2)
If internal appeal fails, you get an independent review by doctors NOT employed by your insurance company.
- • File within 60 days of internal appeal denial
- • Provide same documentation packet
- • Independent review organization (IRO) decides
- • Decision is binding on insurance company
Fix Coordination of Benefits Issues
When you have multiple insurance policies, coordination errors are common but usually fixable.
Common Coordination Scenarios
Dual Coverage (Spouses)
Your plan is primary, spouse's is secondary
Fix: Ensure both insurers have correct primary/secondary info
Medicare + Supplement
Medicare pays first, supplement covers gaps
Fix: Verify provider filed claims in correct order
Auto/Workers Comp
Injury coverage pays before health insurance
Fix: File with injury coverage first, then health plan
Script for Coordination Issues
"I have dual coverage and I believe there's a coordination of benefits error. My primary insurance is [Company A] and secondary is [Company B]. Can you verify the claims were filed in the correct order and reprocess if needed?"
Pro tip: Often requires 3-way call between you, both insurers, and provider
Negotiate Your Patient Responsibility
Even after insurance pays, you can often reduce your remaining balance through negotiation.
What's Negotiable After Insurance
Deductibles
Often reduced via hardship programs
Coinsurance
Your % responsibility portion
Copayments
Fixed amounts per visit
Negotiation Scripts That Work
Financial Hardship Approach
"Insurance covered most of this, but my patient responsibility of $[amount] is still a significant burden. I want to pay what I can. Do you have any hardship programs or payment assistance for the remaining balance?"
Best for: Large deductibles, high coinsurance amounts
Prompt-Pay Discount
"I can pay my patient responsibility balance today. What prompt-pay discount can you offer for immediate payment? I've seen 10-20% discounts offered for same-day payment."
Best for: Smaller balances you can pay immediately
Payment Plan Request
"I want to pay my balance but need to set up a payment plan. Can we arrange $[amount] per month with 0% interest? I'm committed to paying but need manageable monthly payments."
Best for: When you can't pay lump sum but can handle monthly payments
Important: Don't Pay While Appeals Are Pending
If you're appealing any part of your claim, ask the provider to hold off on collections. Say: "I have an appeal pending with my insurance for this claim. Can you place a hold on this account until the appeal is resolved?"
Success Tips
Timing Strategies
- File appeals immediately - don't wait
- Call insurance within 30 days of any denial
- Negotiate with provider after insurance finalizes
Documentation Tips
- Keep all EOBs and correspondence
- Log every phone call with reference numbers
- Get all agreements in writing before paying
Frequently Asked Questions
What should I do if my EOB doesn't match my bill?
First verify the dates and services match. If the patient responsibility amounts differ, call both your insurance company and the provider. Common issues include incorrect coding, coordination of benefits errors, or claim processing mistakes.
How long do I have to appeal an insurance denial?
Most insurance companies give you 180 days to file an internal appeal. After the internal appeal is denied, you typically have 60 days to request an external review. Check your specific plan documents for exact timelines.
Can I negotiate medical bills even after insurance has paid?
Yes. You can negotiate your patient responsibility portion (deductible, coinsurance, copayments) even after insurance processing. Focus on financial hardship, payment plans, or prompt-pay discounts for the remaining balance.
Should I pay while my appeal is pending?
No. You should not pay disputed amounts while appeals are pending. Contact the provider's billing department to request a hold on collections while the appeal is in process. Get this agreement in writing.
Related Resources
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