How To Dispute or Reduce Expensive Medical Bills

If you’re struggling with medical debt, you’re not alone. Medical costs in the U.S. are often unmanageable, and medical debt is one of the main reasons people file for bankruptcy. Even if you have medical insurance, the deductibles, copays, and non-covered services can add up quickly. Mounting medical expenses, high-pressure phone calls, concern about your credit report, and the threat of debt collection lawsuits can make a difficult situation even worse.

Fortunately, there are some simple steps that may be able to help you reduce medical debt to a manageable level. Many people miss out on these opportunities because they don’t know their options. Whether you already have a pile of unpaid medical bills or you’re looking for ways to manage medical debt moving forward, these tips can help.

Get an Itemized Medical Bill and Compare It To Your Explanation of Benefits

Your insurance company will send you an explanation of benefits after it pays out a claim from a medical provider. Keep this handy. It usually comes before your medical bill. Depending on your health insurer and your preferences, you may receive the EOB electronically or by mail.

Next, you should get a bill from the provider. When you receive your medical bills: 

• Make sure it’s not just a summary. If it is, call the billing officer or provider’s office to request an itemized bill immediately.

• Review the bill carefully for charges you don’t recognize. Medical billing is complicated, and a simple typo can mean that you’re charged for the wrong test or for a medication you didn’t receive. It often helps to Google the medical billing code if you don’t understand a line item on the bill.

• Compare the bill with the explanation of benefits (EOB) from your health insurance company. Do the procedure codes match up? Was everything on the medical bill actually billed to the insurer? Did the insurer cover it at the rate you expected based on your plan?

Billing errors are more common than you might think! Don’t assume your medical provider or your insurance provider is perfect. After all, they’re human, too.

What if There’s an Error on Your Medical Bill?

If you find a problem, take action. If the bill from your medical provider contains errors, doesn’t give you full credit for payments made by your insurer, or fails to reflect in-network discounts, contact the provider and ask them to revise the bill. If you can’t get help from the billing office, ask if the facility has a patient advocate you can speak with.

What if Your Insurance Company Denies a Claim?

If your insurance company hasn’t paid for services that should have been covered by your health plan, you can appeal the denial. The appeal time frame is usually limited, so it’s important to review bills and EOBs as they arrive and be sure to act before the deadline if you find a mistake.

Healthcare.gov has a good guide on how to file an appeal with your insurance company.

What Can You Do if You Can’t Afford To Pay Your Medical Bills?

Medical care can be extremely expensive, even if you have health insurance! If you can’t afford your medical bills, you have a few options.

• Ask for financial assistance from the provider’s office.

• Explore community resources.

• Try negotiating your bill.

Ask for Financial Assistance From the Provider

Many Americans don’t realize that they can negotiate their medical bills. But you can! Medical billing department representatives are often authorized to offer a discount of 20% or even more in some cases. If the billing department can’t help you, ask whether the facility has a patient advocate or medical billing advocate.

Here are some examples of the financial assistance that may be available: 

• Some providers, particularly hospitals, have financial assistance programs. These programs assess your need based on your income, the size of your medical bill, and other variables. Depending on your circumstances, they may reduce your bill or even write it off entirely. 

• Some healthcare facilities that receive government funding or grants may offer discounts based on income and other eligibility requirements.

• Your provider might know about nonprofits or state and local governmental programs that could help.

• You might be eligible for Medicare, Medicaid, or some other form of government medical coverage.

• Your provider might be able to offer a payment plan that allows you to make manageable monthly payments over time.

Explore Community Resources

Your provider isn’t the only place to look for assistance. Do some research of your own in addition to seeking their help. One simple way to find resources in your local area is to call 211. That number is reserved by the United Way nationwide. It operates as a central source of information about various types of assistance available in your local area. You can also search for healthcare resources on their website.

Negotiate a Lower Fee by Paying a Lump Sum

If you can’t afford your whole bill, but you’re able to make a significant payment all at once, you may be able to bargain for a lower total cost. 

The ideal time to negotiate for discounted medical care is before you receive the care. Many providers prefer to receive payment upfront. They might be willing to accept less than full price if you are prepared to pay in full in advance. 

Before you reach out to your provider to cut a deal, you should conduct research using the Healthcare Bluebook. This online resource tells you the fair price for different medical procedures. It even color codes providers so you’ll know whether their typical charges for that treatment fall within the fair range.

Don’t worry if you didn’t gather this information and negotiate for a lower price before receiving treatment. When you receive your bill, you can contact the provider. Ask them if they’d be willing to cut the cost if you make full payment of the reduced amount you’re proposing to pay. 

Debt collection can be time-consuming and expensive. So, for some providers, it’s worthwhile to accept less in exchange for being able to mark your account paid in full.

What if a Medical Bill Has Already Been Sent To Medical Collections?

Medical billing can be a slow process. And this remains true for medical debts you dispute. If you’re disputing a medical bill, ask the provider to suspend or extend the due date so you don’t risk being sent to collections while the dispute is pending.

If your bill has already been sent to a debt collector, your best course of action will depend on your situation.

If You’re Disputing the Debt…

You can call the debt collector (or answer when they call you) and tell them the debt is being disputed. It’s helpful to have a paper trail, too, so you can send them a letter as well. In the letter, note when you filed the dispute and ask the debt collection agency not to pursue legal action while the debt is being disputed.

If You Don’t Recognize or Don’t Owe the Debt…

If your debt is sent to collections, you should get a notice from a medical collection agency within five days of the agency first contacting you. Though the agency must, by law, send such a notice, you may find that it contains minimal information about the medical debt. 

If you don’t recognize or don’t believe you owe the debt, your first step is to take action to verify the debt.Call the collections company and ask for the name of the original healthcare provider and the date of service. Then, call the medical facility or doctor’s office that treated you on that date and ask for an itemized bill.

Decide how to proceed from there. If it’s an old debt (past the statute of limitations), you can tell the debt collector to stop contacting you. If you already paid the debt, you can speak with the debt collector and give them the relevant information.

Do Medical Bills in Collections Hurt Your Credit?

Generally speaking, having a collections account on your credit report looks bad and can negatively impact your credit score. But there is some good news. 

The FICO Score 9 — the most recent FICO credit scoring system — and the VantageScore 4.0 both give a lot less weight to medical debt than their previous systems did. Unpaid medical collection accounts will still show up on your credit report, but they don’t have as much effect on your credit score. Once a collections account is paid off, it’s removed from the calculation entirely.

The bad news is that many lenders still use older credit scoring models that give medical collection items more weight. So the effect of a medical debt in collections will depend on what credit scoring model is being used to calculate your credit score.

What Are Surprise Medical Bills and How Do You Handle Them?

A surprise medical bill is an “unexpected bill, often for services received from a health care provider or facility that you did not know was out-of-network until you were billed,” according to the Consumer Financial Protection Bureau (CFPB). 

Prior to the No Surprises Act, which took effect at the beginning of 2022, it wasn’t uncommon to get a surprise medical bill, often months after treatment. The No Surprises Act was passed to mitigate so-called balance billing for services from out-of-network providers given to individuals who had an individual or group insurance plan.

It also provides important protections for individuals seeking medical care who do not have health insurance by requiring medical providers to give patients a good faith estimate prior to delivering medical services.

Should You Use a Credit Card To Pay Medical Bills?

To answer this question, consider these factors:

• Overdue medical bills won’t hurt your credit score as much as overdue credit card bills will. 

• Medical providers or community organizations may be able to offer financial assistance for medical bills; credit card companies don’t offer the same flexibility with their repayment plans.

• Medical providers may be able to offer flexibility with due dates and waive potential late fees or interest charges. Depending on your payment history, your credit card company may be willing to offer this too, but often if you get behind on your credit card payments, a penalty APR kicks in and you’re subject to late fees as well.

Be very cautious if you’re thinking about using credit cards to pay off your medical debt. What can look like a solution in the short term does nothing to reduce the amount of debt you’re responsible for overall. In fact, high interest rates on credit cards can mean that you’ll pay significantly more in the long run. 

Don’t default to using credit cards without exploring all of your options. 

Let’s Summarize…

When you get your explanation of benefits and medical bills, review them carefully. Make sure your insurer has paid for all covered services at the appropriate rate. Research and apply for any available assistance. Consider negotiating a lump sum settlement if you have the funds. Work out a manageable payment plan if possible. 

If you’re overwhelmed by medical debt and other debts, you may want to consider Chapter 7 bankruptcy. You can erase medical debt through a successful Chapter 7 case. Upsolve helps individuals file Chapter 7 bankruptcy for free. Use our free web app to get started.