What Do I Do if I Get an Unexpected Medical Bill?

It’s hard enough when you get bad news from your doctor, but sometimes the drama doesn’t end there: You open your mailbox and get another “surprise” in the form of an unexpected medical bill.

You may receive a bill you didn’t see coming for a variety of reasons. For example, if you haven’t met your insurance deductible for the year, your health plan won’t cover all of your costs until you do. Or perhaps you didn’t get prior authorization from your insurer that was required for treatment.

If you get an unexpected bill, you have two important calls to make.

• Reach out to your insurance company. Call the member services phone number on your insurance card. Find out what they paid and ask why the bill wasn’t fully covered. Take detailed notes, including representatives’ names and reference numbers. This helps you document your dispute. Follow up with an email summarizing the call to create a paper trail; you can ask for the email of the representative you speak with or send a letter to the insurance company’s email address designated for claims inquiries and disputes.
• Contact the provider who sent the bill. Have them explain the charges. Ask for an itemized bill and review it for errors and duplicate charges. “There are likely mistakes,” says Caitlin Donovan, the senior director of outreach and communications at the Patient Advocate Foundation in Hampton, Virginia. “Half of medical bills have errors.” As with the insurer, follow up with an email summarizing the call for your records; you can email the person you speak with or send a letter to the email designated for billing issues and disputes.

Donovan says to never pay any bill until you get your explanation of benefits (EOB) from your insurer, as it shows you what was covered. “If your bill doesn’t match up with the EOB, you’ll know something is wrong,” she says.

Yes. If something isn’t covered, the provider or the facility may have been out of network. But having insurance offers some protections, so you may not have to pay the full amount.

“If you received an unexpected bill from an out-of-network provider, check to see if the No Surprises Act (NSA) might protect you from having to pay,” says Louise Norris, a health policy analyst with HealthInsurance.org. “This [federal] law applies to most health policies, prohibiting unexpected bills from out-of-network providers in emergencies or situations in which the patient was treated by an out-of-network provider at an in-network medical facility.”

She says if the NSA applies to your situation and you shouldn’t have received a bill, reach out to the medical provider’s billing department and your health plan to resolve the issue.

“In my experience, about 60 percent of hospitals will reduce bills by 25 to 40 percent if you simply ask and show even a modest financial need,” says Andrew Lokenauth, a financial adviser and the founder of TheFinanceNewsletter.com, based in Tampa, Florida.

Be sure that you owe as much as they say you do, and review an itemized bill. “I found a $3,000 charge for medication that my client didn’t receive,” says Lokenauth. “The billing department fixed the error. I’ve seen countless cases where hospitals accidentally charge the uninsured rate instead of the negotiated insurance rate.”

Another strategy that helps lower costs is offering to pay a lump sum immediately in exchange for a discount. “Most billing departments have the authority to reduce bills by 20 to 30 percent if you pay right away. I’ve even seen some agree to 40 percent. They’d rather get paid something than nothing,” says Lokenauth.

Lokenauth advises to get everything in writing. “Verbal agreements mean nothing in medical billing,” he says. “Make them email you any promised discounts or payment arrangements.”

Figure out how much you can afford to pay monthly, and offer to pay that amount. Also ask if the provider or facility has an interest-free payment plan.

You can also check if the provider has a financial assistance program and apply for aid. Many hospitals also have financial assistance programs with sliding scale fees based on income. Nonprofit hospitals are required to have a financial assistance policy and post it on their websites.

“Some nonprofit hospitals offer retroactive charity write-offs within 180 days of service if your income qualifies. You must request the application [for the write-off] directly from patient services,” says Kiara DeWitt, a former pediatric neurology nurse in Colleyville, Texas. Her patient advocacy efforts include helping them decode insurance denials and navigate billing misfires.

You can also ask to pay the Medicare price. “It’s likely significantly lower than what uninsured patients are charged,” says Shah.

Find out if your health plan or employer offers a patient advocacy program that offers negotiation assistance. Legal aid services and medical billing advocates can also intervene for low-income patients.