A Step-by-Step Guide to Negotiating Out-of-Network Costs

April 25, 2019

Since providers can decide how much to charge for out-of-network care, that charge sometimes can be higher than you expected. You can use our free Medical and Dental Cost Lookup Tools to discuss and negotiate the cost of care with out-of-network providers.

Out-of-network care is care you receive from doctors or other providers who don’t take your insurance. They’re not in your plan’s network, which means they haven’t contracted with the insurer on a predetermined rate for their services. If you choose to see a provider who isn’t in your plan’s network, or if you don’t have insurance, the provider decides how much to charge.

Providers don’t have to accept a lower fee for a service or procedure, but some may do so if asked. Or, they might offer you other types of discounts or an extended payment plan. Here’s our step-by-step guide to negotiating the costs of your out-of-network care.

Before You Have a Medical or Dental Service: Know What You Will Owe

Step 1: Talk to the healthcare providers you intend to see (or their staff) to ask about the service or procedure you’ll receive. Get the procedure’s billing code and price.

  • If you have insurance, find out which doctors and hospitals are in your plan’s network. Usually you’ll pay less for services performed by in-network providers.
  • If you don’t have insurance or need to go to an out-of-network provider, contact the offices of providers you’re considering. Ask for the name of your service or procedure, whether other services may be included and the code(s) associated with each service.
  • Ask how much the provider would charge for each service or procedure you need.
  • Write down the names of all the people you spoke to and the information they gave you. Ask them to send the information by email as well.

Step 2: If you have insurance, find out if your insurer will cover any of the costs of your out-of-network service or procedure.

Some types of health plans will pay part of out-of-network costs. Some may also help with special situations, such as if you have a rare condition and need to see an out-of-network specialist.

Step 3: Use the FAIR Health Medical and Dental Cost Lookup Tools to estimate the cost of your medical or dental service and compare it to what your provider is charging.

  • Save a copy of your cost estimate results for reference.
  • If you haven’t yet met your deductible, use the in-network price as a guide to see how much you may be able to draw down from your deductible.
  • For certain procedures, the FAIR Health Medical Cost Lookup Tool will suggest services that are often performed with the procedure you searched.
  • Compare the FAIR Health cost estimates to the prices that you were quoted by the providers you contacted. If you have insurance, take into account the amount your insurer will reimburse.

Step 4: Start a conversation with your provider about your payment options.

Is the out-of-network/uninsured price lower than what the provider charges? What about the in-network price? Ask if the provider would consider offering a price that’s closer to one of these estimates. You can also ask about other types of discounts, financial aid or a payment plan.

Step 5: If you have a flexible spending plan, use it.

With a flexible spending plan, you can save by using pre-tax dollars to pay for healthcare services.

Step 6: Build confidence.

Speaking openly with providers about prices can help you build the confidence to shop for healthcare services.

After You Get a Bill: Compare Your Costs and Discuss Differences with Your Provider

Step 1: Review your medical bill closely.

If you and your provider agreed upon a price, does the bill match that price? Look for errors, such as duplicate charges. If you don’t understand your bill or think that it has errors, contact your provider’s billing office.

Step 2: If you haven’t already used the FAIR Health Cost Lookup Tool, use it now.

See if there’s a significant difference between the billed price and the FAIR Health cost estimates.

Step 3: Contact your provider’s billing office and discuss the difference between their charge and the FAIR Health cost estimate.

Ask why the provider has charged a higher price than others in the area.

Step 4: Ask if the provider can match either of the FAIR Health cost estimates.

Your provider may be willing to accept the FAIR Health out-of-network or in-network estimate, or to compromise by accepting less than the initial charge but more than the FAIR Health cost estimates. If so, make sure to get this in writing.

Step 5: Be open to discussion.

If your provider’s billing department won’t accept a lower price, discuss other options, such as a payment plan.

Step 6: Find help.

Find resources that can help you to dispute your medical bill, such as the Patient Advocate Foundation.