When Goodbill CEO and co-founder Patrick Haig launched Goodbill in early 2022, he knew he was about to take a deep dive into the underbelly of hospital billing and learn the intricacies of how to navigate the healthcare system.
Now, hundreds of successful hospital bill negotiations later, Haig is sharing some of the hard-earned tips and insights he’s gleaned from the past year.
"There are a few shortcuts I’ve learned over time that aren’t well publicized at all," Haig said. “All the research online will point you to the same guidance about asking for your itemized bill, but it ends there.”
Here are five insider tips that Haig picked up while negotiating hospital bills, in his own words.
It really is possible to understand your bill and lower it. Early on, we did some customer research to understand how consumers have negotiated their hospital bills in the past. One guy in his thirties told us he would just throw his hands up in the air. He’d think: "I’m just one guy — what can I possibly do against the system?"
Most people probably feel the same way, and it’s disempowering. So most people would be surprised to know that there’s no reason you can’t ask for your detailed billing records, or your medical records, or ask the hospital’s call center to explain something to you. And, if they can’t, keep escalating to their supervisor to try to understand your bill.
If you were an outpatient at a hospital — which is the most common type of hospital visit — stop asking for your itemized bill. Ask for your UB04 instead. Your UB04 is the claim your hospital must send your insurance provider in order to bill them. Over time, I learned that asking for your itemized bill only gives the hospital an opportunity to equivocate and send you their version of an “itemized bill,” which usually won’t have the standardized codes you’re looking for. Then you’ll have to go back and forth about why it’s not the right itemized bill. But there’s only one definition of a UB04, so requesting that is the most succinct and clear way to get the information you’re looking for.
There’s only one definition of a UB04, so requesting that is the most succinct and clear way to get the information you’re looking for.
The exception to this rule is if you were an inpatient at a hospital – as in, your visit entailed an extended stay following a planned surgery, for example. Then you’ll want to ask for both your UB04 and itemized bill, and furthermore you’ll want to make sure that your itemized bill has CPT, HCPCS and revenue codes, which are the industry standard codes. Having both documents is helpful because insurance companies often reimburse for inpatient visits differently — it may be as a bundle, or a percentage of all charges, or some other agreement — so you’ll need as much information as possible.
Read more about itemized bills here.
More than half of the bills that we audit have something wrong that only an expert can catch. That’s kind of crazy. And half of those have something wrong from a clinical necessity perspective — which means, you received and are being charged for a service or procedure that you may not have really needed.
More than half of the bills that we audit have something wrong that only an expert can catch. Half of those have something wrong from a clinical necessity perspective.
I remember we got a 26-year-old patient who went to the ER for radiating shoulder pain. He was otherwise healthy and exercised a lot, but came out with a bill that was over $6,000. We’d just started reviewing bills for clinical necessity, in addition to coding errors or unfair pricing, and we were able to flag clinically unnecessary care within the first 5-10 minutes. We found $2,000 in patient balance that should have never happened, just from the over-ordering of labs. The hospital ended up accepting our offer, and we ended up saving him 58%, or $3,900, off his bill.
A lot of people would be surprised to know that there are faxes everywhere in healthcare. You fax letters, documents, authorizations. You might have to do that if you’re a parent and you need to associate the other parent with your child; or if you’re submitting a financial assistance application. Or, after you do all the legwork to understand your bill, you might have to fax or mail in the letter. It’s incredibly slow.
For the 26-year-old patient whose bill we got lowered by $3,900, we sent in his negotiation package and the hospital immediately confirmed it was under review. But get this: It then took 26 phone calls to the hospital to push it across the finish line.
As you call in to make requests for your UB04, itemized bill, or other information, recognize that the people you’re speaking to on the phone are often overworked and paid very little. Recognize that — but also, don’t take them as authority. If you’re asking about procedure codes or your legal rights, it’s highly unlikely they’ll know anything about that. It’s highly unlikely they’re trained in your HIPAA right of access to records. It’s not in their job description. So if someone says, “You can’t have that,” don’t take it at face value.
If someone says, “You can’t have that,” don’t take it at face value. Generally speaking, the higher the seniority, the higher the power to discount your bill.
If you ever feel like you’re hitting a roadblock, you can take two tacts:
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Guides, news, and articles to help you tackle hospital bills.
Read our expert tips on how to negotiate your hospital bill to save up to thousands of dollars.
Itemized bills provide key details that can help you negotiate your hospital bill.
You have time before your bill can go to collections or affect your credit.