I am unable to pay for my care up front

A guide to help you lower your up-front health care expenses

From negotiating with your provider to connecting with patient advocate departments to help you apply for a hospital financial assistance program, set up a no-interest repayment plan or lower your bill.

Quỳnh Chi Nguyễn

Associate Director, Community Catalyst, Center for Community Engagement in Health Innovation

You may have done everything right — working to get a “good faith estimate” or making sure your care is in-network — but your health care provider still requests you to pay for your bill, or a portion of it, up front. Increasingly, this may occur even before you are able to receive care. 

Even so, you can try to negotiate with your provider to lower the amount you have to pay up front and/or in total. Some hospitals or community organizations have patient advocate departments to help you negotiate to apply for hospital financial assistance program, set up a no-interest repayment plan, or lower your bill.

Apply for a hospital financial assistance program

It is never too late to see if you’re eligible for financial assistance. Many hospitals, especially non-profit hospitals, provide financial assistance programs in the form of free care (also called “charity care”) or discounted care to uninsured and insured people. Hospital financial assistance policies are usually posted on the hospital’s website. You may also call the billing office to ask for more information.

Explain your financial situation and ask if you can speak to someone about whether you are eligible for financial assistance. Be respectful and patient, but ask clearly for the help you need. Don’t take “no” for an answer. 

If you need help applying for financial assistance, contact Dollar For. You may also contact a legal aid organization in your area for assistance.

Work out a payment plan

If you don’t qualify for financial assistance, work directly with your doctor or hospital on a repayment plan. Sometimes, if you offer to pay a portion of your bill right away, they will offer you a discount. Many health care providers offer low- or no-interest repayment plans over several years.

Get it in writing: Make sure to get these payment agreements in writing. In some states, certain health care providers may be required to develop reasonable payment plans to ensure affordability for patients.

For example: In Colorado, hospitals are banned from billing low-income patients more than 4% of their monthly income each month and, if the patient has made 36 payments, the hospital has to forgive the remaining amount and consider the bill paid in full.

Negotiate to lower your bill

You may be able to negotiate to get a discount. For example, tell the hospital that you cannot afford the full cost and ask what they normally bill insurance companies or what Medicare pays. Ask if you can pay that lower amount. Don’t take “no” for an answer. Be polite but persistent. If you need to, ask if there is someone else you can talk to. Express your willingness to pay, but explain what your limits are. If they agree on a discounted price, get the agreed-upon price in writing.

Tips for repayment plans: After you have settled on a price, ask if you can set up a no-interest repayment plan over 24-30 months. If the provider agrees to a payment plan, get it in writing and make sure it includes language stating that you will not be charged interest, late fees, or other penalties. Sometimes, the provider may pressure you to sign up for a medical credit card or medical loan to pay your bill. DO NOT give in.

If you are late in paying your medical bill, offer to make a payment today — and ask if they can waive the late charges and any interest accrued.

Avoid using a credit card to pay for your medical bills

Some doctors and hospitals ask for a credit card up front. You do not have to provide your credit card number, but be aware that the provider may not agree to treat you. Instead, find another provider willing to treat you without taking your credit card information in advance.

Avoid signing up for medical credit cards or medical loans

Some health care providers, including dentists and eye doctors, offer medical credit cards or medical loans to patients who don’t have insurance coverage or can’t afford to pay for treatments. 

These medical financing schemes are marketed toward patients, and are increasingly being used to finance the payment of medical coinsurance and copayments. Many of these products contain introductory or deferred-interest features during a promotional period, which may seem very appealing. However, if you cannot afford to pay off entire balance in full by the end of the promotional period, these financing products can become a debt time bomb, as you may be subjected to significant and unexpected interest expenses, which are calculated at extremely high rates.

Three reasons why should not use a credit card to pay for your medical bills

  1. You lose the ability to negotiate
    As soon as you pay with a credit card, the doctor or hospital has no reason to negotiate the amount of the bill because they have already been fully paid. If something happens that makes it difficult to pay off your credit card debt, you won’t be able to work out a no-interest payment plan with the hospital or doctor. Instead, you will be stuck paying late charges and high interest to your credit card company.
  2. Late fees and high interest rates can make your medical bill even more expensive
    If you don’t have enough money to pay off your medical bill in full right away, setting up a no-interest payment plan with your provider will be less expensive than the potential interest and late charges associated with your credit card. 
  3. You could lose your medical debt protection rights
    Some federal and state laws offer stronger consumer protections for medical debt than for credit card debt. However, if you pay your medical bill with a credit card, you lose those medical debt protections. 

For example: Federal law prohibits credit bureaus from adding medical debt to your credit report until payments are past due for one year. But that protection does not apply if you paid for the medical bill with a credit card.

What’s the difference between medical credit cards and medical loans?

Medical credit cards

Many medical and dental providers offer medical credit cards for patients to finance care. Once a patient signs up for a medical credit card, the patient can use the card repeatedly until reaching the credit limit.

  • Medical credit cards are primarily offered through three financial companies: CareCredit, a subsidiary of Synchrony Financial; Wells Fargo; and Comenity, a subsidiary of Bread Financial.
  • Many medical credit cards are “deferred interest” credit cards, which often harm the most financially vulnerable patients. 
  • Deferred interest credit cards are often advertised as “no interest” or “0% interest” for a specified time period, such as 12 or 18 months. If the patient pays off the full balance before the end of the promotional period, the patient will pay no interest on the purchase. 
  • However, if any portion of the balance remains after the promotional period, interest is assessed on the entire purchase, going back to the original purchase date. This includes interest on amounts that have already been paid.  
  • Patients who pay deferred interest pay significantly more interest than they would have paid if they had used another credit card. This is because the interest rate on deferred interest credit cards is much higher than the interest rate on most general-purpose credit cards. 
  • Between 2015 and 2020, about one in five health care purchases with a deferred interest product were not paid off by the end of the promotional period. Deferred interest was assessed on these purchases. 
  • On average, patients who are not able to pay off their purchases by the end of the promotional period pay an additional 23 percent of the purchase price in interest charges. 

For example: A patient pays for a $2,500 medical bill using a one-year deferred interest plan and pays off all but $100 by the end of the year. The next bill will include interest on the entire $2,500, dating back one year. If the interest rate is 25%, patient will owe nearly $400 in interest fees.

Medical Installment Loans (also called Care-Now-Pay-Later Loans)

  • Some medical providers offer installment loans, which allow the patient to split the cost of treatment into separate payments over time.
  • Medical installment loans are offered through companies such as AccessOne, Prosper, PayZen, and Walnut. 
  • Medical installment loans differ from medical credit cards in that they are typically offered before a treatment, and they are only authorized to cover the cost of that treatment.
  • Some medical installment loans have zero interest or low interest. Other medical installment loans have interest at the market rate or higher, depending on the patient’s credit risk.
  • Some medical installment loans have deferred interest terms. As noted above, deferred interest financing often harms the most financially vulnerable patients.
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Authors

Patricia Kelmar

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 policy advisor at NJ Health Care Quality Institute, associate state director at AARP New Jersey and consumer advocate at NJPIRG. She was appointed to the Ground Ambulance and Patient Billing Advisory Committee in 2022 and works with patient advocates across the U.S. Patricia enjoys walking along the Potomac River and sharing her love of books with 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.

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