What to Do When You Get a Huge Medical Bill

Opening a huge medical bill can make your stomach drop. Take a breath. The number on that first bill is often not the final number, and you usually have more options than it seems. The most important thing to know right now: don’t rush to pay it, and don’t ignore it either. Work through the steps below first.

Step 1: Don’t pay it yet, and don’t put it on a credit card

Paying right away can make it harder to fix errors or get a discount. And moving a medical bill to a credit card turns it into regular credit card debt with interest, which usually loses the flexibility and protections that medical debt can have. Hospitals and providers are often willing to work with you on payment plans, often interest-free.

Step 2: Compare the bill with your insurance paperwork

If you have insurance, wait for the Explanation of Benefits (EOB) from your insurer. It shows what was billed, what insurance paid and what you owe. Make sure the provider’s bill matches. Common problems include:

• The provider never sent the claim to your insurance
• The claim was denied for a fixable reason, like a coding error or missing information
• You were billed for more than your EOB says you owe

If a claim was denied, you have the right to appeal. Call your insurer and ask why, and what you need to do.

Step 3: Ask for an itemized bill

A summary bill doesn’t show what you were actually charged for. Ask for a fully itemized bill with billing codes.

Step 4: Check every line for errors

Billing mistakes are common. Look for:

• Services, tests or medications you didn’t receive
• Duplicate charges
• Charges for a longer stay than you had
• Canceled tests that were still billed
• Wrong dates, wrong name or wrong insurance information

If you find something you don’t understand, call and ask. You can search a billing code online to see what it means. Dispute anything that’s wrong, and keep notes.

Step 5: Know your rights on surprise bills

Federal rules under the No Surprises Act protect many people from certain surprise out-of-network bills, like emergency care or some care at in-network hospitals. If you were uninsured or paid cash, you may have been entitled to a good-faith estimate, and can dispute a bill that’s much higher than that estimate. Rules have details and exceptions, so check the CMS No Surprises page or the CFPB for current guidance.

Step 6: Ask about financial assistance (charity care)

Many hospitals, especially nonprofit hospitals, are required to have financial assistance policies. Depending on your income, you might qualify for a large discount or even have the bill forgiven. Many people who qualify never ask.

Apply even if you think your income is too high. Eligibility limits vary and can be more generous than people expect. You can often apply even after the bill is sent.

Step 7: Negotiate what’s left

If you don’t qualify for assistance, you can still negotiate.

• Ask for a self-pay or prompt-pay discount. Some providers reduce the bill if you pay a lump sum.
• Ask for a lower rate. If you’re uninsured, ask them to bill you at a rate closer to what insurers or Medicare pay.
• Set up a payment plan. Ask for an interest-free plan with a monthly amount you can actually afford. Don’t agree to more than you can pay.
• Get every agreement in writing before you pay.

If the bill is already in collections

You still have rights. You can ask the collector to validate the debt, dispute it if it’s wrong, and ask whether the original provider will still consider financial assistance. Medical debt reporting rules have been changing, so check your credit reports for free at AnnualCreditReport.com and see the CFPB for current information on medical debt and collections.

You’re not alone

Medical debt isn’t a personal failure. It’s a very common problem, and there are people whose job is to help. Call 2-1-1 or visit 211.org to find local assistance.

This is general information, not financial, legal or medical advice.