Steps to take if hit with a big medical bill

By Tom Murphy
Posted on September 08, 2023

An enormous medical bill can trigger a wave of panic, but that startling invoice that arrived in the mail may not be what you wind up paying.

Errors or slow insurance payments may have inflated the total. Even if it’s accurate, financial aid or other assistance can help.

Sometimes a simple phone call clears up a problem. Other times, reinforcements are necessary.

Debt experts say patients should attack medical bills with a plan. Here are the key steps to take:

Check the numbers

Don’t stash the bill in a pile of mail and hope it goes away. But don’t rush to pay it without first understanding the amount.

“Especially if it’s a really high bill, consider it like an opening offer,” said Caitlin Donovan, a spokesperson for the nonprofit Patient Advocate Foundation, which helps critically or chronically ill patients deal with debt and insurance problems.

Medical bills can be rife with errors. They also may have been sent before insurance coverage was sorted out.

First, compare the bill with your insurer’s explanation of benefits. That’s a document the insurer sends that explains how your coverage will apply to the care you received. It can give you a sense for what you may still owe based on your deductible or the plan’s out-of-pocket maximum.

If something looks weird, call both the insurer and hospital for an explanation or itemized bill.

But be aware that those bills also can be hard to interpret or contain errors that have little to do with the charge, Donovan said.

Know the (new) law

The No Surprises Act debuted last year and offers a layer of protection. Patients should check to make sure their care provider is following that law.

It prevents doctors or hospitals in many situations from billing insured patients at higher rates when the care providers are not in their insurer’s coverage network.

The law protects most emergency care by requiring patients to receive in-network coverage with no additional billing from the provider.

It also protects patients from huge bills for lab work or an out-of-network anesthesiologist when the patient is treated at an in-network hospital.

The Centers for Medicare and Medicaid Services has established a “No Surprises Help Desk” for people who have questions about whether their medical bill complies with the law. They can call 1-800-985-3059 or submit a complaint online.

Seek outside help

There are many for-profit and nonprofit organizations that can help people navigate medical bills.

The Patient Advocate Foundation helped David White recoup more than $2,000 he paid for routine lab work after his kidney transplant.

“Every single penny that I paid out was refunded,” said the 61-year-old White, a volunteer foundation board member. “There’s just no way I could figure this out on my own.”

The foundation offers an online directory of potential resources for medical or prescription bill help.

Outside help might also include a state attorney general’s office, which may have a health advocacy unit or a consumer protection division.

Be very wary of any “medical credit card” a provider may offer you, said John McNamara, a principal assistant director with the federal Consumer Financial Protection Bureau. Those cards may come with high interest rates or terms that can hurt the patient financially if the debt isn’t fully paid in a certain time frame.

Plus, patients who jump at that offer may miss out on other financial assistance, or their insurer may not be billed, McNamara noted.

Financial assistance

Once you have checked for errors, ask for financial assistance. Some hospital systems may provide help for people with income levels as high as six figures.

“People a lot of times assume they won’t qualify,” Donovan said.

Many hospitals don’t do a great job letting patients know about available help, said Marceline White, executive director of Economic Action Maryland, a nonprofit that helps people in that state apply for financial assistance.

“The onus is on the patient to apply for the assistance and do the work,” she said.

Ask for a discount if no financial assistance is available.

Bargain and budget

You’ve checked for errors and asked about discounts and financial assistance. Now you may have to confront a final invoice.

Ask about a payment plan. Many hospitals will offer options with no interest or a very low rate.

But before committing to a plan, go over your budget to get a sense for what sort of payment you can handle. Donovan noted that people who agree to a monthly bill that turns out to be too high may wind up having that debt land in collections if they can’t make payments.

“Then you’re in a whole new problem,” she said.