Haris Ashley
Medical bills can be confusing and complicated, and it's easy to lose track of payments. If you have unpaid medical bills, there are several options to get them paid or at least on a path toward being paid off. First, it is important to confirm that you owe the bill and that the amount is correct. You can then explore various options for financial assistance, including government programs, insurance coverage, and payment plans. If you are insured, the law may protect you from certain billing practices, and you have the right to dispute or appeal charges that you disagree with. If you are uninsured, you may be eligible for financial assistance or discounts, and you can also negotiate with the healthcare provider for a reduction in the bill.
| Characteristics | Values |
|---|---|
| Federal and state laws | May protect you from some medical bills and provide protections from debt collection and credit reporting |
| No Surprises Act (NSA) | Protects you from "surprise billing" if you have health insurance and provides some protections from surprise medical bills if you are uninsured |
| Financial assistance programs | Provide free or discounted health care to people who need help paying their medical bills |
| Medicare | Offers help with prescription drugs and other costs |
| Medicaid | Provides help with medical bills |
| Debt management plan | Involves a payment schedule that a credit counselor develops based on your situation |
| State agencies | May offer helpful information and a complaint process |
| Health insurance company | You have a right to an "internal appeal" and an "external review" of the charges |
| Medical bill | Compare it with your explanation of benefits and figure out what you're expected to pay |
| Health provider | Be upfront about what you can pay |
| Payment plan | Many medical providers can work out a no- or low-interest payment plan |
| Charities, churches, and advocacy groups | May give grants based on need |
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What You'll Learn
- Check eligibility for financial assistance or charity care programs
- Understand your rights under the No Surprises Act protecting against unexpected out-of-network medical bills
- Explore government programs for free or low-cost care
- Negotiate a no- or low-interest payment plan with your provider
- Contact a billing advocate for help with negotiating and planning
Check eligibility for financial assistance or charity care programs
If you are unable to pay your medical bills, you can check your eligibility for financial assistance or charity care programs. These programs provide free or discounted health care to people who need help paying their medical bills. They are sometimes offered by medical care providers and states. Non-profit organizations or advocacy groups may also be able to help.
To check your eligibility, you can start by contacting the hospital or medical office where you received treatment. Hospitals with 501(c)(3) nonprofit status are required to have financial assistance or charity care programs. Ask for a copy of their financial aid policy, which should include eligibility criteria and instructions on how to apply. You can also search online for their policy by typing the hospital name and "financial assistance" into a search engine.
Even if the hospital is for-profit or private, they may still have a financial assistance policy that can help. Ask the billing department about their policy and eligibility requirements. Some states have charity care laws that require hospitals to provide free or discounted care to patients who meet certain requirements, often based on income.
If you are insured, it is important to check your health insurance policy documents and explanation of benefits to understand what is covered and what you are expected to pay. You can also contact the No Surprises Help Desk for help in over 350 languages and information in accessible formats. If you disagree with the charges or need more information, you have the right to an internal appeal and an external review of the charges.
There are also government programs that offer free or low-cost care for specific health conditions, such as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the Ryan White HIV/AIDS Program. Eligibility for these programs is often based on income, age, insurance coverage, and health issues.
If you are experiencing problems with your health insurance or are unable to resolve a billing dispute, you can seek help from Consumer Assistance Programs in your state or territory. You can also contact the Consumer Financial Protection Bureau (CFPB) for assistance with medical debt and billing issues.
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Understand your rights under the No Surprises Act protecting against unexpected out-of-network medical bills
Effective January 1, 2022, the No Surprises Act (NSA) protects you from surprise billing and provides some protections from surprise medical bills if you are uninsured. The Act supplements state surprise billing laws and creates a "floor" for consumer protections against surprise bills from out-of-network providers and related higher cost-sharing responsibilities for patients. Here are your rights under the No Surprises Act:
Protection from Out-of-Network Charges
If you are insured, the law bans certain practices, like requiring you to pay out-of-network charges for emergency services. This includes banning out-of-network cost-sharing (like out-of-network coinsurance or copayments) for most emergency and some non-emergency services. You can't be charged more than in-network cost-sharing for these services. The NSA will protect consumers from surprise medical bills by requiring private health plans to cover these out-of-network claims and apply in-network cost-sharing. This applies to both job-based and non-group plans, including grandfathered plans.
Protection from Balance Billing
The No Surprises Act can protect you from owing the difference between the out-of-network billed cost and the amount your health insurance paid. This practice, known as "balance billing," occurs when out-of-network providers bill you for the difference between the billed charge and the amount your health plan paid. The NSA prohibits doctors, hospitals, and other covered providers from billing patients more than the in-network cost-sharing amount for surprise medical bills.
Right to Dispute Charges
If you are uninsured or choose not to use your health insurance for a service, you can often get a good faith estimate of the cost of your care upfront before your visit. If you disagree with your bill, you may be able to dispute the charges. Additionally, the Act outlines a process for your insurance company and the provider to settle disputes over the provider's charges, ensuring a fair resolution.
Protection from Surprise Billing for Supplemental Care
The NSA bans out-of-network charges and balance bills for certain additional services (like anesthesiology or radiology) furnished by out-of-network providers as part of a patient's visit to an in-network facility.
Protection for Emergency Services
Surprise billing protections apply to most emergency services, including those provided in hospital emergency rooms, freestanding emergency departments, and urgent care centers licensed to provide emergency care. The NSA also covers air ambulance transportation (emergency and non-emergency) but not ground ambulance transportation.
It is important to note that some services, such as ground ambulance transportation, are not protected by the No Surprises Act. Additionally, if you are facing difficulty paying your medical bills, there are various government programs, financial assistance programs, and debt management plans that may be able to provide support.
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Explore government programs for free or low-cost care
There are several government programs that can provide free or low-cost medical care. These programs are typically means-tested, taking into account factors such as your income, age, employment status, and any qualifying health issues. Here are some of the programs you can explore:
- Medicaid: This program provides free or low-cost health coverage to low-income individuals, families, children, pregnant women, the elderly, and people with disabilities. In some states, Medicaid has been expanded to cover all adults below a certain income level.
- Children's Health Insurance Program (CHIP): CHIP provides low-cost health coverage to children in families that earn too much to qualify for Medicaid.
- Medicare: If you are eligible for Medicare, you can get help with paying for prescriptions through Medicare Part D. Medicare Savings Programs may also be able to assist with Part A and Part B premiums, deductibles, coinsurance, and copayments.
- Ryan White HIV/AIDS Program: This program provides help with HIV/AIDS medications and treatments based on your income. You must be uninsured or your current insurance plan must not cover the treatments and medications you need.
- National Breast and Cervical Cancer Early Detection Program (NBCCEDP): This program offers free or low-cost breast and cervical cancer screenings.
- State-specific programs: Each state may have its own unique programs to assist with medical costs. Contact your state social service agency or visit USA.gov to learn about the specific programs available in your state.
In addition to these programs, you can also explore options such as charity care, which provides free or discounted health care to those who need help paying their medical bills. You can also reach out to organizations like the Healthwell Foundation, the Patient Access Network (PAN) Foundation, and the UnitedHealthcare Children's Foundation for assistance with costs not covered by insurance or help in finding grants.
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Negotiate a no- or low-interest payment plan with your provider
If you're struggling to pay your medical bills, negotiating a no- or low-interest payment plan with your provider can be a good option. Here are some steps and strategies to help you through the process:
Firstly, it's important to act quickly to avoid late fees and interest accruing. Contact the accounting or billing office of your provider as soon as possible. Be honest and upfront about your financial situation and what you can afford to pay. It's in their interest to recoup at least a portion of what you owe, so they may be more open to negotiation than you think.
Before you negotiate, make sure you understand your medical bill. Compare it with your explanation of benefits if you have insurance, and check that you actually owe the bill. It's possible that you've already paid it or that there's been a mix-up with someone else who has the same or a similar name.
When negotiating, remember that you have leverage. If you're insured, you may be protected by the No Surprises Act, which can shield you from certain out-of-network charges. If you're uninsured, you can ask to pay what insured patients or programs like BlueCross or Medicaid would pay. You can also look into financial assistance programs, sometimes called "charity care," which provide free or discounted healthcare to those who need help with medical bills.
If you're unsure about negotiating on your own, you can hire a medical bill advocate to do it for you. These experts in medical billing can help you spot potential errors or overcharging and reduce the amount you owe. Just be careful to choose a reputable advocate to ensure your information stays safe.
Finally, when agreeing to a payment plan, make sure you can afford the terms. Ask about any associated fees or charges, and break down the total bill into equal payments over a few months until it's paid off.
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Contact a billing advocate for help with negotiating and planning
If you're facing difficulties paying your medical bills, you may benefit from contacting a billing advocate for help with negotiating and planning. Billing advocates are experts in the field of medical billing and can provide valuable assistance in navigating the complex healthcare system. Here are some steps you can take to engage their help effectively:
Identify a Suitable Billing Advocate
Locate a billing advocate who can assist you with your specific situation. You can search for advocacy groups that specialize in helping individuals with medical bills in your state or for a particular disease or condition you have. For instance, the California Medical Billing Advocates (CALMBA) is a non-profit organization dedicated to reducing or eliminating unjust medical bills. They have a team of experts, including ex-healthcare finance executives and lawyers, who provide free assistance. You can also check if the hospital where you received care has a patient advocate on staff. Additionally, look for non-profit organizations like The Foundation, which assists individuals with chronic or life-threatening illnesses in obtaining and paying for care.
Understand Your Rights and Options
Before engaging with a billing advocate, it's essential to understand your rights and options regarding medical billing. Familiarize yourself with laws and protections that may apply to your situation. For instance, the No Surprises Act (NSA) protects you from "surprise billing" if you have health insurance and provides some protections if you are uninsured. Additionally, federal and state laws may offer protections from certain medical bills, debt collection, and credit reporting. Understanding these rights will empower you to make informed decisions and work effectively with your billing advocate.
Provide Necessary Information
Once you have identified a suitable billing advocate, provide them with all the relevant information regarding your medical bills. Gather and organize your medical records, billing statements, insurance information, and any other documentation that may be pertinent. This will enable your billing advocate to thoroughly understand your situation and identify areas where they can assist you.
Negotiate and Plan with the Advocate's Guidance
Billing advocates are skilled in negotiating medical bills and can help you navigate the process effectively. They can review your bills for any errors, inflated charges, or unjustified balance billing situations. They may be able to negotiate with healthcare providers to reduce or eliminate certain charges. Additionally, billing advocates can assist you in developing a payment plan that is manageable for your financial situation. They may suggest options such as no- or low-interest payment plans offered by some medical providers.
Explore Additional Resources
In addition to negotiating and planning, billing advocates can direct you to other resources that may help with your medical costs. They can inform you about financial assistance programs, often called "charity care," which provide free or discounted healthcare to those struggling with medical bills. They can also guide you toward government programs, such as Medicare and Medicaid, that can offer financial support for medical expenses. By leveraging the expertise of billing advocates, you can gain a better understanding of your options and make more informed financial decisions regarding your healthcare.
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Frequently asked questions
First, make sure that you owe the bill. You could have already paid it or the provider may have confused you with someone else. If you are unsure, talk to the accounting or billing office of your provider. If you disagree with the charges, you have the right to an appeal with your health insurance company. You can also dispute a medical bill with a debt collector or a credit reporting company.
The No Surprises Act is a federal law that protects insured people from "surprise billing" for emergency services. This usually occurs when you receive care at an out-of-network facility and your insurance does not cover the out-of-network cost. In these cases, the NSA protects you from owing the difference between the out-of-network billed cost and the amount your health insurance paid.
Many medical providers can work out a no- or low-interest payment plan for your medical bills. You can also look into government programs that can help pay for medical care, such as Medicare, Medicaid, or charity care.
Contact your medical insurance company, as they should have a record of any medical bills they paid partially or give you an idea of what healthcare provider to start with. You can also contact clinics or hospitals where you remember receiving care and they can tell you if you owe them money with some basic information about yourself.
If you don't have insurance, ask for a "self-pay" or "cash-pay" discount as you are paying the bill out-of-pocket. Many healthcare providers will give a discount if you pay immediately, but do not pay immediately as you might be able to reduce the bill further. Be upfront about what you can pay and try to negotiate the total cost.
