Negotiate a lab bill

Medicare publishes what it pays for every lab test. That number is your starting point when a bill looks too high. Here is what to check first, what to have in front of you, and what to say.

First: should you owe this at all?

On a covered Part B lab test, Medicare pays its rate and you owe $0. The markup bites when you sign an ABN, pay out of pocket, or the claim is denied.

So before you talk price, check which of these you are in:

• Medicare denied the claim. Appeal first. A denial can be reversed, and then the price question may go away. Appeal a denial →
• You signed an ABN. Ask the lab for a copy of the signed form. If there is no valid ABN, the rule below applies.
• You paid out of pocket, or the test was never billed to Medicare. This is where negotiating does the most good.

The lever: Medicare’s rate

Medicare pays labs from one public price list, the Clinical Laboratory Fee Schedule. When a bill charges several times that rate, you have a reasonable, documented number to ask for. Billing offices can often discount, and a specific number gives them something to say yes to.

Before you call: four numbers

1. What they charged for each test, from an itemized bill. If the bill only shows a total, ask for the itemized version first.
2. Medicare’s rate for each test. Check a bill reads it off the bill for you, or use rate lookup one test at a time.
3. The gap between the two, in dollars and as a percentage. Check a bill shows both.
4. Another lab’s price for the same tests, if you can get one. Find a lab shows what labs near you have charged.

The phone script

Call the billing number on the statement. Keep it short and polite, and take notes.

If you signed an ABN, add one line: “Please send me a copy of the ABN I signed for these tests.”

Put it in writing

If the call does not settle it, send a short letter to the billing office. Include the account number, each test with its charge and Medicare’s rate, the amount you are asking them to accept, and a date for their reply. Keep a copy, and keep your notes from the call.

If they won’t move

• Ask for an interest-free payment plan on whatever you do owe.
• Ask them to hold the account, not send it to collections, while you are talking.
• Your state attorney general’s consumer-protection office takes billing complaints.
• Your U.S. Representative’s or Senator’s office has caseworkers who help constituents with Medicare billing problems.

Medicare Advantage?

The rates here are Original Medicare’s. If you have a Medicare Advantage plan, compare the bill with your plan’s Explanation of Benefits first, and check the Medicare Advantage page for the network and balance-billing questions to ask.

For information only. Not legal or financial advice.