Learn how to negotiate the balance you owe your physician

Negotiate With Your Physician

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If you have a health plan that sends you EOBs (explanation of benefits) describing what was paid to your physician, then it is important to validate the accuracy of their payment and your financial responsibility on the claim. Each time a health plan considers a claim, whether it is paid, partially paid, pended or denied, an EOB should be forwarded to both you and your physician about the action they took.

The following items will determine the amount of your personal out of pocket expense when a claim is submitted to the health plan:

1. Are there differences in payment between participating and non-participating providers?
2. Under what circumstances is a deductible or copay applied?
3. What are the deductible and copay amounts?
4. At what percentage will the health plan pay?

You could find the answers to these questions by reviewing your policy booklet  By reviewing your EOB for accuracy you save yourself anguish by avoiding late notices from the physician's billing office asking you to pay any remaining balance, helps you point out a potential system/billing error with the physician's billing office, and it also helps you learn more about your policy, which will be beneficial in helping you avoid a potential similar problem in the future.

If you do receive a bill from the physician and it is accurate, you could work with the physician's billing office to reduce the amount you owe or if you are required by your health plan to pay the remaining amount in full, you could at least ask for a payment plan if the amount owed is large.  If you are paying by cash you should never pay full charge, for the primary reason that health plans also never pay the full charge.  Negotiating a significant discount with  your physician is crucial and asking ahead of time what will be your financial responsibility are benefits and will reduce surprise and risk.

• Negotiate patient balances yourself.  Our Appeal Letters and Guides have been used by actual patients.  To review available guides and appeal letters, click here and review the List of Available Appeal Letters related to Patient Balance Issues..

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Health Symphony provides information as a general resource and does not guarantee any results, expressed or implied, obtained from its use.