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What NOT To Do When You Get a Large Medical Bill

medical bills

Guest post from Beth of LivingWithBeth.com

Even if you have good health insurance, you could end up with some impressive medical bills if you (or anyone else on your policy) need surgery, become seriously ill, or are involved in an accident.

I’ve learned a lot from my experiences with large medical bills, and while every situation and insurance company is different, there are a few things you definitely should NOT do!

Don’t Ignore the Bills

The absolute worst thing you can do is toss all those medical bills into a stack and forget about them. Depending on the laws where you live, hospitals might be able to seek a judgment against you for garnishing your wages or put a lien against your house or other property. They could turn over your account to a collection agency, which may harass you and damage your credit.

I realize that going over medical bills is the last thing you want to do when you’re recovering from an illness or injury, or helping a family member through a health crisis. However, ignoring bills won’t make them go away.

If you have low or no income, you might qualify for charity care. The hospital might also help you locate other options to help you pay your medical bills.

You don’t know until you try, and you should do this as soon as possible. If nothing else, you can call or write a letter saying that you’re still too sick to make payment arrangements, but paying bills is important to you. Give them a date (maybe two weeks in the future) when you would like to speak with someone.

Don’t Pay the Bills in Full

Even if you have enough of an emergency fund to pay a large medical bill without flinching, hold off until you have more information. You’ll want to go over statements and insurance explanations of benefits (EOBs). Plus, you could negotiate a smaller amount for payment in full.

It’s usually not a good idea to pay medical bills using a home equity line, credit card, or other loan. Hospitals sometimes charge zero or very low interest on their payment plans and may require smaller monthly payments.

Don’t Assume You Have All the Paperwork You Need

Some hospitals only send itemized statements upon request. If you’ve signed up to receive health insurance documents by email, they won’t send you a paper document, either.

Before you pay anything, you should scrutinize your hospital and provider statements to make sure that you received all of the services listed on them. Then, compare the EOB to the hospital statement to make sure your insurance was billed correctly.

If you receive bills from other providers besides the hospital, check to make sure that the services weren’t denied coverage by your insurance company. One reason they might decline coverage is if the service was already billed as part of the hospital’s bill.

I’m not saying that providers intentionally try to double dip like this, but I’ve seen it happen, whether by accident or on purpose. Many people will get a bill from a provider and pay it rather than check to see why they’re receiving the bill and why the services were covered, or not covered, in the manner they were.

Don’t Send Random Payments

Hospitals aren’t likely to accept a payment of $10 or $50 here and there as a good faith repayment effort. You need a formal payment schedule. You could also look into any financial assistance available to patients with low income, no insurance, or high-deductible health plans, depending on your situation.

Don’t Pay Someone to Negotiate Your Medical Bills

You don’t need to pay anyone to negotiate your medical bill. You can do it on your own.

Most hospitals want to work with you so they get paid. Even if they are nonprofit, they need to pay the employees and other bills. They wouldn’t have money to keep the lights on if they didn’t work with patients to arrange bill payments.

Some companies offer an employee benefit involving a company that can help negotiate medical bills or at least compare hospital statements to insurance EOBs. If you think this might be the case for your employer, check with your human resources department.

Don’t Be Rude

I prefer to negotiate in writing, but I often have to follow up with a phone call to finalize payment arrangements. I’m always super nice, and everyone I’ve talked with has been very pleasant as well.

If you get on the phone with someone who is extremely unhelpful despite your remaining calm and polite, tell him or her that you’re sorry but will need to call back at another time.

Then, hang up and call back the next day at a different time to see if you get someone else. Most hospitals have at least a few different people in their billing department who answer customer service calls.

The person might have been having a bad day, or perhaps dealing with customers isn’t his/her main job. Write down and save the names of everyone you talk with, along with the dates and times. In the unlikely event that you get nowhere with billing staff, ask to speak to a supervisor.

Remember that you’re negotiating a win-win situation. They’re doing you a favor by accepting affordable payment arrangements. You’re doing them a favor by voluntarily reaching out to them to put together payment plans, unlike many patients.

One Note About How to Write a Negotiation Letter for a Medical Bill

At the top of your negotiation letter, include your address and the name and address of the medical facility. Also, include the patient’s name, billing ID number and date of birth. Include the balance and dates of service and suggest a monthly payment.

Don’t Skip a Payment

If something keeps you from making a payment, call the billing department to request skipping a payment or lowering your monthly obligations.

Do you have any other tips for those with large medical bills? 

Beth McIntire writes for the lifestyle blog LivingWithBeth.com, where she shares tips, how-to posts, solutions to common problems, reviews, deals and more.

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38 Comments

  • Keelie says:

    I’ve negotiated plenty of my large medical bills to something manageable. It is best to never stop paying them. You can always go back and re-negotiate if you need to.

  • Chris says:

    Don’t throw any medical bills for at least seven years. I read in a book once where someone got an old bill and they had their records. I think it was seven or eight years they said to keep the bills. They could prove they had paid it.
    Also, ask if you get a discount for paying cash.

  • Sarah says:

    We have always had insurance, but the level of coverage varied from child to child after their birth. After each delivery, I always called the insurance company and had them go over the (EOB) with me, line by line. I got almost $1000 off of one bill because of several errors (on their part). Every dollar counts and if the bill is substantial, I always call and ask.

    • I’ve always heard of people doing this, but I’ve never done it myself. I just had a baby and the bills are starting to come. Can you share any more information with me? I’m just not sure I’d even know what to look- or listen- for. What sort of items were on the bill in error?

      • Chris says:

        An example I had an error on a bill. I had three hospitalizations and two surgeries, two years ago. I had to be on IV nutrition for a month. I was told my insurance would cover it because I had already met my out of pocket for the year. However, they charged me for it. When I called the insurance, it was a simple thing to take care of. I don’t remember the problem but it was very simple for them to fix it.

      • Chris says:

        Here is an example for you, Abby – Two years ago, I had three hospitalizations and two surgeries. I had to be on IV nutrition for a month. I was told verbally at the hospital that it would be covered, as I had already met my out-of-pocket. However, on an EOB it showed up that I would owe it. I called the insurance company and explained it to them. I don’t remember exactly the reason it wasn’t covered, but they took care of it after my phone call.

      • Cara says:

        Abby,
        My husband and I both work in health care. Always ask for an itemized bill from your hospital stay. For both YOUR hospital stay and services AND for your baby’s hospital stay and services. Just call the hospital billing dept and before you pay ANYTHING, always always ask for an itemized receipt. (not probably necessary for a simple blood draw at the out patient lab, for example).
        I have found MANY errors…both from the provider billing the insurance company and from the facility where the care was received. I like this post…very timely and important!

      • Brandy says:

        A few years back I had surgery on my ankle. I requested an itemized bill from the hospital. In addition the ankle procedure, I was charged for surgical procedures on my shoulder AND jaw. Insurance processed every line item on the claim and paid.

      • Sarah says:

        For example, one time they tried to bill more for a medicine they never gave me. Another time, they tried to tell me I didn’t contact them to let them know I was going in to have the baby. I was in labor so I went in. They charged me $500 because I didn’t notify them ahead of time. 🙂 They apologized and understood it wasn’t prearranged. 🙂 One time I was charged twice for something that could have only have happened once. My best advice is to just block out an hour of your time to be on the phone and have them explain every detail. If you need to call your doctor to have them explain it to you too, do it. $1000 is a lot of money to save!

  • Jessica says:

    If the bill is due to an accident on someone else’s property or from a car accident, look into MedPay from the auto insurance/homeowner’s insurance policy. If you take legal action against the at-fault party, the health providers may put a lien on your judgment. Your lawyer can negotiate a lower fee, but any contractual adjustments from insurance would not apply in that case.

  • Diane says:

    I have saved money so many times by catching errors in insurance processing claims by asking , sometimes several times , for them to reprocess claims that I knew were incorrect. Also, when you talk to insurance, get a reference number and write it down.

  • Julia says:

    This post was very interesting. We are with Samaritan Ministries, whom I really appreciate. We are able to negotiate huge dollar amounts off our bills because we’re considered self-pay.

  • Jen says:

    I saved us $378 this spring by going over my EOBs and comparing them to what I was billed. In both instances, the doctor/hospital billed me for physician services that they were not allowed to bill based, per the insurance company. I called both (after calling insurance to ensure I was reading the EOB correctly) and the bills were corrected.

  • Jennir says:

    Set up a payment plan right away. When I did this, I was given a several hundred dollar “prompt pay” discount.

    Many providers will ask for a deposit up front. However, claims are paid based on when they are presented for payment. Make sure you confirm that the “down payment” was really needed for that provider. When I called to have it returned to me, the gal sheepishly admitted it would have taken them several months to get it back to me. My call would speed up the process.

    Keep detailed records. Dates, times, who you talked to, etc. Try to get an email address or fax number and then fax or email a summary of the conversation.

    Three way calling. If your insurer and provider are in disagreement, use 3 way calling and get both parties on the line. You are paying BOTH parties to serve you. They need to come to agreement.

  • MomofTwoPreciousGirls says:

    I had a Mirena put in two years ago and it was supposed to be 100% covered. Initially the insurance company tried to make me pay for a pregnancy test the office did before the procedure and for an ultrasound 2 weeks later to verify it was properly placed. I wrote a letter appealing it because of course they have to make sure I’m not pregnant prior to placing it and endangering a fetus and of course they have to check that it’s in the right place to avoid the 20k for having a baby when it doesn’t work!

    My appeal was approved and they paid the bill.

  • Christie says:

    After any bills have gone through insurance and I receive the actual final bill, I call the number listed and ask for a discount if I pay the balance of the bill in full that day. From my experience, hospitals and diagnostics (labs and imaging–X-rays, MRIs, CT scans) will typically provide a discount of some sort-anything from 5-35%. Providers usually do not offer any incentive for paying in full.
    After having my son, my hospital bill was over $2500 after insurance. They offered a 25% discount if I paid in full, so I read them my Discover card number over the phone (then promptly paid the credit card bill in full with money we’d saved in anticipation of baby bills!) The anesthesiologist and OB did not adjust their prices, but would set up payment plans with 0% interest. While I was told no many times, it was worth the hour on the phone with all the places I owed after he was born to save over $1000.

  • Jennifer says:

    Our local hospitals have awesome financial assistance programs. The children’s hospital always gives a discount Even if you have insurance. They also have programs to help pay if you are self pay or have high deductibles. Even if you do not qualify for your states “free” medical , children’s hospital has a much higher income threshold. My son required dental surgery , $15,000 ! They gave us 100 percent assistance. Huge blessing! My daughter required an ER visit , $2000 and we were able to get an 80 percent discount. Always ask if there is an assistance program through the hospital! They work with many charities and non profits and it can be s huge help.

  • Chris says:

    Also, check your EOB’s very carefully. I was charged and paid and didn’t realize the problem until months later for over $600 worth of lab that had a wellness type diagnosis instead of the problem I had. I wrote letters and called several times and finally it was taken care of almost two years later.

  • Laura says:

    This is all very good advice. One additional thing I would like to add is to expect bills to come in way after your procedure. I was a little shocked the first time this happened. We received a very significant bill about 7 months afterwards. I was upset because the provider and I had agreed that it was all paid off. They neglected to tell me about the anesthesiologist and other specialists who bill separately.

    Also, my husband has a “regular” job. We qualified to have ALL of our expenses from the hospital paid for. This time around we knew we still had to pay all the specialists. I called each one and made separate arrangements. Some took the hospital’s stance and forgave our bill, some (but not all) reduced the amount we owed.

    Once we met our high deductible, to make the most of it we made appointments for a couple elective things we had put off.

    Everything adds up! It is worth the extra work.

    Good article!

  • Maryalene says:

    Not really a tip but more of a heads-up: one thing that surprised me when my husband was going through cancer treatment was that every department in our hospital bills separately. And nothing was itemized. So I’d get a $250 bill one day and a $250 Bill the next and assume they were duplicates when in fact they were for two separate departments. It was a nightmare to keep them all straight. In my perfect world, the hospital would send out one bill for all the services conducted under their roof.

  • Something to also consider is to be sure the hospital has your up to date insurance information. We had an experience in our family where the clinic did update my son’s insurance information in their system, even though they had copy’s our new cards. We received the bill for his broken leg and were floored with the out of pocket amount. After calling and diving into the issue, we discovered that their information was outdated in their system. After their update, they ran the claims again and the bill was significantly lower.

  • Kristin says:

    “Don’t ignore bills” is excellent advice in general. If you’ve had a hospital stay or ER visit, you will get a lot of bills. It’s important to keep track of them all. I overlooked one from a surgery a couple of years ago. It was just a small amount, $25 I think, and the provider turned it over to collections within about 6 weeks!

    For that same surgery, the bill from the hospital offered a discounted amount if I paid in full by a certain date – you bet I did!

    • Bo says:

      A lot of people do not realize that you can get a pretty decent discount (10+%) by paying in full, on-time. You do have to call to pay the bill and specifically ask, I’ve noticed. I found out almost by accident before the birth of our first son and it has saved me quite a bit of money over the years. Obviously this is a little easier to tackle if it’s a baby instead of an unexpected surgery.

  • Melinda says:

    Even when someone’s dies check everything on bills. My Dad died after a lengthy stay in the hospital. The bills kept coming, I took the time to call all of the various offices. Most of the ones that I talked to when they found out he had passed away if the bill was under $100 they forgave them. That was such a relief ,most were so kind expressing how sorry they were for my loss. Some even remembering him. Usually hung up the phone in tears!

  • Chris says:

    I worked for a nonprofit hospital. Sometimes they forgave a large portion of a bill for people without insurance if you brought all your bills/income in and had a consultation session with them. I had a friend with an over $20K bill who got it down to $200!

    • Jenni says:

      This is SO important. We were grateful to discover that he hospital my husband had outpatient surgery at forgave 100% of the bill for those with an annual income of less than 200% of the poverty level. Our insurance had not covered all services and we were left with a decent bill. We then looked at what our surgeon had charged ( a separate bill) and realized that the covered portion was discounted 70% to the insurance company, but the uncovered portion was not discounted at all. We asked for a discount, explaining that he was a law student with a family, and they wrote off 50%. It saved us several thousand dollars in bills to do all of this, and now, we always make a point of going to the nonprofit hospital just in case the bill is crazy high.

  • Camille says:

    As a medical biller, always dispute the charges and request an itemized bill. There are many errors that go through and patients pay without questioning. When you write a letter to have a bill reduced, always include the term “financial hardship” when explaining why you cannot pay the amount you are responsible for. For some reason, that is a magical phrase and I have seen many invoices reduced by 25-75% by just using that term. If you do not ask for a discount, the answer is always no.

  • Elizabeth says:

    I work for a medical billing company. Until I started this job I had no idea how INCREDIBLY complicated medical billing is. There are hundreds of insurance carriers, and each of them have a bunch of different plan options. And they ALL pay differently. There are thousands of procedure codes and thousands of diagnostic codes. There are literally thousands of details for us to try to remember. And if we forget some tiny little detail, and the claim gets rejected by the insurance company, we have to do it again, and every time we bill, the insurance company has 60 days to respond. It easily takes a year or more to get some claims processed. MISTAKES HAPPEN ALL THE TIME. Do not trust your bills and EOBs, ALWAYS double-check. And if you think you’re owed a refund, always call, refunds are almost always last on the priority list.

  • Lisa says:

    For those of you who have negotiated a discount for bills paid in full what % did you get taken off? How did you make sure it reflected paid in full? Any tips appreciated.

  • Melinda says:

    I am so grateful to God for drawing me to read this article! It was very timely for my family because my 2.5 year old boy/girl twins recently had surgery and then my son was hospitalized. We have saved over $3,000.00 by asking for discounts. Thank you!!

  • Tanya says:

    Also a good one is to ask your doctor if the lab they use for blood work/other testing is contracted with your insurance. Or if your doctor even verifies this. Some doctors do NOT!

  • sally says:

    Another hint…ask for financial assistance. When our college aged son had an accident we had a LARGE final bill despite having good insurance. So…after a few calls I was able to apply and receive financial assistance …cutting our final billing almost in half…Never know….maybe if you ask …you’ll receive…what a blessing!! 🙂

  • Christina says:

    My husband was temporarily booted off of Medicaid without warning and had a procedure done while he was uncovered (and didn’t know it). Had he known, he would have purchased private insurance to cover himself temporarily until he could get Medicaid back. Instead, we wound up with a nearly $4,000 bill that we have had to pay a bit at a time every month out of our own pocket when it should have been completely free. Even if you are on government assistance, don’t assume they will always cover you! We are back on Medicaid (he has a severe disability and I’m taking care of our two young kids, so I only work part time right now), so it is truly a struggle to have to pay additional bills that should have been covered. 🙁

  • Suzanne says:

    If you receive a bill for something that has been denied by your insurance company, ask both the insurance company and the hospital why it was denied. I learned a while back that their versions of events don’t always match.

    In this case, the hospital claimed not to know why the insurance company denied some charges incurred in the emergency room. Then they said that the insurance company told them the services weren’t covered by my policy. (I checked my EOB, they definitely were covered.) I then called the insurance company; they denied the charges because the hospital hadn’t filed the claim until a month after the filing deadline.

    Not my circus, not my monkeys. I called the hospital and the bill was voided. Always, always, always double check.

  • My wife has been in and out of the hospital for the last couple months and our medical bill has been piling up. I like your advice to not send any kind of random payments but to communicate effectively with the hospital. I never knew that there is financial assistance you could receive, if you quality. Thanks again!

  • Kimberly Walker says:

    Make sure that you once you get on a payment plan, that you follow the hospital payment plan exactly and follow their instructions. We had been on a payment plan for quite awhile, when the computers at the hospital had a glitch, rebilled everything, which caused us to have to go through an audit with the insurance company. Our hospital billing specialist told us to NOT pay until the audit was finished, as it would cause more problems in the long run. We were told to come in every month, speak to our specialist who made a note in our file. Once the audit was finished, we went back to our payment plan and continued making payments, which ended up being lowered because during the audit, it was discovered that there had been an additional $1000 by the insurance that hadn’t made it to the hospital before the audit started. We ended up owing $1000 less than we thought!!!! Also, keep good notes. Who you talked with, their operator number, the date, what was discussed, when to call back and then keep everything related to that bill all together in one folder!

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