NEW YORK — Unexpectedly High medical bills are common in the United Statesbut there are ways to get relief. According to the Consumer Financial Protection Bureau, one in five Americans is affected by outstanding medical debt, costing a total of $88 billion.
In a 2022 study, the office found that about 20% of U.S. households report having medical debt, with collections appearing on 43 million credit reports. In the second quarter of 2021, 58% of all bills charged to credit records were medical bills.
Medical debt also affects families unevenly, according to the agency. Past-due bills are more prevalent among blacks and Hispanics than whites and Asians, and medical debt is more common in the American South, in part because states in that region have not expanded Medicaid coverage.
While the process of combating high medical bills can be time-consuming and frustrating, advocates stress that patients should not be intimidated by the system. If you’ve received a surprise medical bill, here it is what you should know:
When Luisa, 33, received a medical bill of more than a thousand dollars after an emergency visit to the hospital for a viral infection, she managed to get the entire amount covered by the hospital after turning to her financial assistance policy.
“At first I thought it was just a cold, but it ended up being something I needed specific medication for,” said Luisa, who asked to be identified only by her first name for privacy reasons. “It was really bad when I went to the emergency room.”
Luisa heard about the patient advocacy organization Dollar For thanks to a viral video and filled out the nonprofit’s online form after receiving her surprise bill. The organization contacted the hospital, which was in central Florida. Finally, the hospital contacted Luisa directly to inform her that she did in fact qualify for financial assistance. Even though she had already paid a portion of the costs with a credit card, Dollar For was able to get those payments reimbursed.
Laws governing hospital charity care require nonprofit hospitals to reduce or write off individuals’ bills depending on family income. To determine if you qualify, simply Google the hospital along with the phrase “charitable care” or “financial assistance policy.” Dollar For also provides a simplified online tool for patients to see if they qualify.
“Federal law requires hospitals to have these programs to maintain their tax-exempt status,” said Jared Walker, CEO of Dollar For. “If you are within their income range, they will write off, waive, forgive or reduce your bills.”
Even if you’re already paying off medical debt, the hospital will be obligated to reimburse the payments you’ve made, he said.
“It was the first time I went through something like this,” said Luisa. “I tried to be an informed consumer and ask questions when I was in the hospital about costs, but obviously it’s difficult when you’re sick in the emergency room.”
While there have long been protections against surprise bills for those with Medicare, Medicaid and Tricare, there are now laws for those with private or marketplace insurance as well.
The federal No Surprises Act covers people who have insurance through their employers, the marketplace, or individual plans. It states that insurance companies must reasonably cover any out-of-network services related to emergency medical care and some non-urgent medical care. This means if you’re paying more than you’re used to or expect when you receive in-network services, that bill could be illegal.
To object to any bill covered by this law, you can use the free technical support and hotline of Centers for Medicare and Medicaid Services. Many states also have free consumer assistance programs to help with disputes and insurance issues. You can always contact any hospital’s medical billing department in writing to say that you believe a bill violates the No Surprises Act and ask the hospital to deal directly with your insurer.
“The complexity of the system itself is as big a problem as accessibility,” said Kaye Pastaina, who leads research on patient protection at KFF, a health policy nonprofit. “Much of this is due to the fragmented system and complex rules, but also a lack of awareness about existing protections that are part of federal law that can help.”
Even if you don’t qualify for charity care or aren’t sure your bills are covered by the No Surprises Act, you may be able to reduce your charges.
Medical billing is notoriously byzantine and rife with errors. Whenever you receive a bill, ask the hospital or healthcare provider for an itemized bill that includes the bill codes for all the care you received. The Health Insurance Portability and Accountability Act (HIPAA) requires providers to share this information.
Then verify that the billing codes are correct. Again, simply Googling codes with the phrase “medical billing code” can help. If something is wrong, disputing your bill with your doctor or doctor’s office may result in changes.
Another approach: compare the invoice with insurance companies’ estimates of fair charges for services. If the price charged is higher than average, you can reduce your costs. You can even take the provider to small claims court over the discrepancy (or let them know you have a case).
Finally, compare your insurer’s “explanation of benefits” to the invoice. This explanation of covered and non-covered costs must correspond to the hospital bill. Otherwise, you will have another reason not to pay and to ask the provider to work more with your insurance company first.
Despite the hassle, these steps can save considerable amounts of money. Even after taking these steps, you can always appeal health claims with your insurer if you think there is some reason why the bills should be covered in full or more than the company initially decided. You can also contact your state’s insurance commissioner for support.
“What we saw in our research and in the data is that those people who do appeal – and there are very few who do appeal – but for those who do appeal, there is a high level of rollover,” Pastaina said.
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