There is perhaps no scarier field to navigate as a consumer than the health insurance industry. Grappling with medical bills can be especially stressful. You might already be feeling vulnerable after putting your health and safety into a doctor’s hands. Maybe you’re even still recovering from a procedure. Trying to sort through medical bills that seem like they’re written in a foreign language just makes the situation worse.
In a nationally representative Pew Research Center survey of 2,537 U.S. adults, 83 percent of respondents considered high treatment costs that made quality medical care unaffordable “a big problem.” This can lead people to delay seeking care because they fear the financial impact. But sometimes you need expensive preventive care or wind up in an emergency situation, leaving you with medical bills that can cause frustration and anxiety.
Before we dive into expert advice on navigating big medical bills, it’s important to acknowledge that even being able to do so is, in many ways, a privilege. It typically requires a lot of time and energy (often during regular business hours), and is generally easier if you have health insurance. If you’re LGBTQ+, a woman, a person of color, have a disability, or have another (or many) marginalized identities, it can be even harder to get people to listen when you try to advocate for yourself. While many of the tips here are broad, some of them do speak to these concerns specifically.
With that in mind, read on for advice from health equity advocates and health insurance experts on how to avoid big medical bills or, if necessary, deal with them after the fact.
1. Try to estimate your costs ahead of time.
If you know you have some kind of medical procedure coming up and you have insurance, have a conversation with your doctors, hospital, and your insurance company to get a ballpark of what you’ll owe.
First, ask your providers and hospital if they are in-network. Them being in-network means they accept your insurance, which likely translates to a much lower bill. Double-check what they say with your insurance provider, if you have one, and make sure you’re getting information for all of the major care providers involved in your procedure (like your surgeon, anesthesiologist, etc.), since some of them may have different insurance policies. (It may be easier to first ask the hospital if they can verify that all providers involved are in-network for you.)
Then ask your primary care provider and hospital for as much detail as possible about the procedure you’re having and what it might cost. If you have insurance, call them and ask them to help you break down possible out-of-pocket costs based on what your doctor and hospital told you.
If English isn’t your first language, you have the right to speak to someone who can communicate clearly in your primary language. While the patient’s bill of rights can vary from hospital to hospital, one of the overarching requirements is that people have access to health services in a language they are comfortable with, which may require an interpreter.
Beyond that, there are pricing tools online that can help you assess the standard rate for your procedure. FAIR Health is one national option, and you can Google for more local options, too.
However, don’t take any of this information as a guarantee of what you’ll pay. “Often, the doctor, the hospital, and the insurance company don’t know what the [others] are doing,” Jane Kaye, a former chief financial officer at two New Jersey hospitals, tells SELF. This can lead to different estimates from different sources. Plus, your providers might adjust aspects of your care as it happens.
“You could have a bad reaction to a particular medication [or] need an additional treatment, which would add to your bill,” says Kaye, who is also a consultant for hospital billing departments at HealthCare Finance Advisors.
However, Kaye says even confirming that your hospital and doctors accept your insurance and getting a ballpark idea of what your procedure costs can give you a better idea of what to expect.
2. If you’re uninsured, try to sign up for a plan.
This is another step you might try if you have some time to prepare before a procedure. Having health insurance is often a worthwhile investment, but it’s a particularly good idea if you know you’ll be going in and out of a doctor’s office in the near-future.
If you can’t afford insurance, check to see if you qualify for Medicaid, which provides insurance for many people and families with low incomes. Many people qualify for Medicaid and don’t realize it, Elisabeth Ryden-Benjamin, vice president of health initiatives at the Community Service Society of New York, an anti-poverty advocacy organization serving New Yorkers, tells SELF. Qualification is based on your income and family size; here’s how to see if you’re eligible.
Qualifying for Medicaid can drastically reduce the amount you’ll owe, as federal regulations prohibit out-of-pocket costs for Medicaid beneficiaries from being more than 5 percent of a family’s income.
If you’re not eligible for Medicaid but have recently had what’s known as a qualifying life event (divorce, marriage, had a baby, lost your job, etc.), you can try to enroll in your state’s health insurance marketplace. Normally you can only enroll in marketplace plans during open enrollment (usually November and December, though it may be longer depending on what state you live in), but these situations grant you an exception.
If enrolling in a health insurance plan just isn’t an option right now, see if you can go to a low-cost or free health center to get the care you need. Federally-funded health centers provide care for underserved populations, often on a sliding scale. Find one close to you here.
3. Call the hospital billing department to confirm your insurance information.
So, you did your research, maybe even signed up for health insurance if you didn’t have it before, and you’re still staring at a bill that doesn’t seem quite right. You’re not alone: According to a nationally representative 2018 Kaiser Family Foundation poll of 1,201 people aged 18 and older, 39 percent of insured adults had a higher-than-expected medical bill in the past year.
Receiving the bill might feel catastrophic, but experts agree that you shouldn’t immediately panic—or pay it. “The biggest mistake people make is they’ll see the bill and automatically pay,” Claire McAndrew, director of campaigns and partnerships at Families USA, a health care advocacy organization, tells SELF. “Consumers are so worn down that they think they don’t have any recourse. But there are often solutions.”
Calling the hospital billing department to confirm they have the right insurance on file is a good first step. Health care technology is notoriously antiquated, so it’s plausible that the high number you see is an error. “There are many places where things could have gone wrong,” Kaye says. “When you showed them your insurance card, they could have keyed in one wrong thing. That very first misstep can cause problems down the road.”
4. Call your insurer to better understand your bill.
Unless you’ve opted out, health insurance companies will email or mail you an explanation of benefits (EOB) after you’ve visited a doctor or hospital to explain what exactly they will and won’t cover. Parsing through your bill and EOB can be overwhelming. “I teach health care finance at Rutgers, and I bring in real-life bills to show students how complicated it is,” Kaye says.
To make it easier, have someone at your insurance company walk you through what the numbers and codes on your bill and EOB mean. This can help ensure that they’re covering everything they’re supposed to and that you weren’t accidentally billed for a service you didn’t receive.
If you’re on Medicaid, you should be shielded from sticker shock because of those federal protections we mentioned above. So, if any out-of-pocket costs seem exorbitant, call your state’s Medicaid office to see if your bill is accurate.
5. Ask the hospital for a prompt pay discount or payment plan.
If a medical bill seems accurate but is still too expensive for you to pay, ask the hospital for a prompt pay discount, which is when they reduce your fee if you pay the charges in full right away. Not all providers offer this, but most do, Kaye says, adding that the discount is often 10 to 20 percent.
If you’re not in a position to pay your bill in full, ask the hospital’s billing department about a payment plan. This can be a multi-year plan, and the experts note that sometimes you can pay as little as $5 a month. Hospitals would rather have someone be willing to pay a little bit at a time instead of ignore the bill altogether, Kaye says, so they are typically willing to work with you on a plan you can manage.
Even if you agree on a set amount per month, it’s always worth asking if you qualify for any additional discounts on your bill, Ryden-Benjamin says. This is especially important if you’re uninsured, as many hospitals have charity care programs that can greatly reduce (or even eliminate) your bill if your income is low enough or your situation is extreme enough.
6. File an appeal with your insurance company.
If you can’t come to an agreement with the hospital on a payment plan or you still feel your insurance should cover more, you may want to file an appeal with your insurer. Every insurance provider handles appeals differently, but you can often find steps for the appeal process on the company’s website, like Aetna’s guide here.
If your appeal is rejected, Ryden-Benjamin recommends trying again. “It’s a pain in the neck for [hospitals and insurers] to keep dealing with you,” Ryden-Benjamin says, meaning that sometimes being persistent will be enough for them to grant your appeal and lower your costs.
Be sure to let the hospital know as soon as you’ve filed an appeal with your insurance company, Kaye says. Some hospitals will put your bill on hold, so they won’t expect payments at that time. Not all will, Kaye says, but the three main U.S. credit agencies allow a grace period of 180 days before an unpaid medical bill impacts your credit report. That’s around six months, giving you a bit of wiggle room to fight for a fairer bill.
Here’s more information on how to appeal an insurance claim.
7. Find advocates to fight or even pay on your behalf.
Hospitals have patient advocates to help you make your way through the complex world of health care. Ask to speak with one, explain your situation, and see if they are able to offer financial guidance.
There are also external advocacy organizations that can help you figure out if your charges are fair, work with you on appeals, or even help cover your costs.
For instance, Community Health Advocates, a free service that operates under the Community Service Society of New York, works with the privately insured, publicly insured, and uninsured to navigate the minefield of health care bills. This can include filing an appeal on a consumer’s behalf, and their free helpline (888-614-5400) offers guidance in over 170 languages.
Research similar consumer assistance programs nationally and in your area. If you live in a state or region with limited resources, this is where your state department of insurance can come in handy. “They can contact the hospital and your insurance to serve as an advocate,” McAndrew says.
There are also countrywide organizations like the National Patient Advocate Foundation, which has no-cost case managers to help advocate on behalf of patients. They are associated with the Patient Advocate Foundation’s co-pay relief program and financial aid fund, which both offer financial assistance to people who meet certain income-based and health-related criteria.
Going the advocate route can be a particularly good option for non-English speakers or people with marginalized identities who are more vulnerable to poor treatment within the health care system. It could be easier to have an advocate working on your behalf than to take on all this labor yourself.
8. Call your elected officials.
Two Senators and one House representative have filed legislation against surprise medical billing in the past year, and President Trump expressed desire in January to make sure people know exactly how much a procedure might cost before getting anything done. It’s unclear how that would work because, as Kaye says, hospital care tends to have many variables. However, McAndrew notes that this is seen as one of the only bipartisan health issues in government.
If you get a surprisingly high bill, call your elected officials and let them know, McAndrew says. Although it likely won’t affect your current bill, making your voice heard may compel your elected officials to act. If everyone who got a surprise bill made that phone call, it could get us closer to a future with more transparent health care billing.