What can I do about my expensive medical bill?
First, check your bill to make sure it is correct:
- Verify the name and address on the bill. Is this your bill? If it is, review the bill carefully.
- Be sure your bill lists the details of all charges. If not, request an “itemized bill” from the health care facility and/or the providers who treated you.
- Check the list of charges and make sure you recognize all the types of care on the bill. Billing departments and insurance companies can make mistakes, so follow up if something does not look right.
- If you do not understand your bill, call the billing office or your health insurance plan to ask questions.
If you call your health insurance plan or a billing office
Keep notes of your conversation: include the date, time, name of the person you’re speaking with, and what they tell you. Save all bills and documents from your provider and health insurance plan, and keep them together in the same, easy-to-find place.
DID YOU KNOW? Many hospitals provide financial assistance to patients who cannot afford to pay for their care. Before you pay for anything, ask if you are eligible for a free or discounted care program. DO NOT sign up for a medical credit card or a medical loan.
If you have insurance
Make sure you are looking at the bill, not the “Explanation of Benefits” (EOB). Usually, an EOB arrives before the medical bill itself. An EOB is not a bill. An EOB is a summary of the care that you received and shows the amount your insurer is billed, how much your insurance will pay for that care, and the amount that you will owe.
If you do not have insurance
If the bill is $400 or more than the “good faith estimate,” ask your provider to adjust the bill to the amount in the “good faith estimate.” (See Guide 3: I Am Uninsured and Need Medical Care to learn more.)
What should I do if the medical bill looks incorrect?
Providers and insurance companies can make mistakes when billing patients. That means you could get billed more than you should. Here are some common types of mistakes on medical bills.
Improper charges for services or medicines you did not receive
This error can happen to anyone. Call the billing office to tell them and report the errors to your health insurance plan. Make sure to call the phone number on the back of your health plan’s insurance card and ask to speak with their “fraud department” to dispute the charges included in your bill.
Insured patients may encounter other common errors — including, but not limited, to billing errors, improper claim denials, and illegal “surprise medical bills”
More common mistakes
Compare your bill with your Explanation of Benefits (EOB). If they don’t match up, call your health insurance plan to find out why.
A denied claim happens when your health insurance plan refuses to pay for a service that you received, so the provider charges you for the full amount of that service. If you believe that your health insurance plan has mistakenly denied a claim, you can appeal that denial of coverage with your health insurance plan. Instructions on how to start an appeal should be listed on your Explanation of Benefits (EOB). Otherwise, call the phone number on your health insurance plan’s card.
Surprise medical bills
Your bill may include illegal “surprise medical bills” from an out-of-network provider. Under the No Surprises Act, many providers who are not in your insurance network are not allowed to bill you. You may only have to pay your normal in-network costs (deductible, copay, coinsurance).
For more information, see Guide 1: I Have health insurance and Need Emergency Care and Guide 2: I Have Insurance and Need to Schedule Hospital Care. Learn how to dispute illegal bills under the No Surprises Act below.
Not billing insurance first
Sometimes your health care provider sends a medical bill to you before the insurance company has made its portion of the payment. If happens to you, call your insurer to see if it has made payments to the provider. Then, ask your provider to send you an updated bill that reflects the amount due after your insurer has paid.
Are you unsure about a bill?
If you think you’ve been sent a bill you should not have to pay, and can’t get your health insurance plan or the health care provider to fix it, file a complaint with your state attorney general’s office. Your local legal aid office may be able to help as well.
How do I fight an illegal, out-of-network “surprise medical bill”?
The No Surprises Act protects people with health care insurance from extra charges from certain out-of-network providers in particular situations.
You should never receive a surprise out-of-network bill if:
- You receive medical care at an emergency room (E.R.)
- You are transported by air ambulance (airplane or helicopter)
- You receive scheduled care at health care facilities in your health insurance plan’s network.
In these situations, you should only pay what you would normally pay as a copay, coinsurance, or toward your deductible. The out-of-network provider cannot send an additional bill.
If you have received an illegal, “surprise medical bill” from an out-of-network provider, follow these steps:
STEP ONE: If you have received an illegal, “surprise medical bill” from an out-of-network provider, immediately notify your health insurance plan. If your health insurance plan does not resolve the situation for you, contact the provider who sent the bill and tell them they have sent you an illegal, “surprise medical bill.”
STEP TWO: If the provider still demands payment, file a complaint at the government’s No Surprises Help Desk or call 1-800-985-3059. Language support is available if you need help filing your complaint.
STEP THREE: Check your credit report to make sure your bill was not sent to collections. It should NOT be listed on your credit report. Here is how to check.
What if I already owe my hospital money? Can I still get care?
If you need emergency care, any hospital must accept you as a patient and treat you for that emergency — even if you have a bill that you haven’t paid.
However, if you do not need emergency care, a provider may refuse to treat you if you have an outstanding bill with them.
More guides in this series
Senior Director, Health Care Campaigns, U.S. PIRG Education Fund
Patricia directs the health care campaign work for U.S. PIRG and provides support to our state offices for state-based health initiatives. Her prior roles include senior director of health policy with the National Consumers League, senior policy advisor at NJ Health Care Quality Institute, and consumer advocate at NJPIRG. She serves on the board of the Patient and Caregiver Engagement Advisory Group for the National Quality Forum. Patricia enjoys walks along the Potomac and sharing her love of books with her friends and family around the world.
Quỳnh Chi Nguyễn
Associate Director, Community Catalyst, Center for Community Engagement in Health Innovation
Quỳnh Chi Nguyễn oversees two major projects on community benefits and economic stability, and hospital equity and accountability. She also supports local and state health advocacy organizations that are working to improve economic stability. Quỳnh Chi has expertise in several policy areas, including affordability, health insurance coverage, prescription drug costs, and health justice. She is similarly experienced in policy research and analysis on community sustainable development, poverty reduction, child protection, and human trafficking in Southeast Asia.