What to Do if You Get a Massive Medical Bill

It’s scary to receive a medical bill that’s costlier than expected. Medical debt can sometimes lead to bankruptcy and hurt things like your credit score and ability to buy a home.

Some let the payment notices pile up unopened because they’re afraid of the cost. It’s human nature to avoid unpleasant news, said Annelise Moss Bretthauer, certified financial planner and founder of Kauviara Financial Planning.

“But the longer you wait, the less time you have to plan,” she said.

With the right plan of attack, medical debt — even massive medical debt — can be manageable. Use the following tactics to figure out what you owe and how much you ultimately need to pay.

Why are some medical bills so high?

Outsized medical bills typically come from out-of-network care that isn’t covered by your insurance plan. Almost half of emergency department visits and hospital inpatient admissions trigger out-of-network billing, according to a study in JAMA Internal Medicine. This is known as as “surprise” or “balance” billing. The average liability from these visits more than doubled between 2010 and 2016.

Learn more about finding affordable health insurance here. 

In the face of an emergency, it’s obviously difficult to ask whether every person who cares for you is within your insurance network. But even planned, non-emergency care like outpatient surgery could result in a surprise bill. That’s because even at an in-network facility, certain out-of-network providers (especially anesthesiologists) might be involved.

Here’s a basic guide to how health insurance works.

Time is (sort of) on your side

In 2017 the three major credit reporting agencies (Experian, Equifax and TransUnion) changed the way medical debt is handled. They included a 180-day waiting period before unpaid debts are included on credit reports.

This gives consumers more time to ensure all insurance payments are paid, and helps determine how much of the balance they actually owe. The first bill you get might have the words “insurance pending” — if so, don’t pay it yet. Your insurance company may still foot some of the bill.

Read the medical bill carefully to find out what you’re being asked to pay (we have a guide here). Circle any treatment or service you don’t remember getting, then call the provider’s billing department. It could be as simple as someone entering the wrong billing code.

“Humans are doing all this, and humans make mistakes,” said Bretthauer.

Other mistakes could be harder to spot, like being charged for individual versus bundled treatments. If your medical debt is sizable, consider hiring a medical billing advocate, a professional who can locate billing errors and even get part of the debt forgiven.

Some medical billing advocates work for an hourly fee and others take a percentage of the money they save you. You can find an advocate in your area via the Alliance of Claims Assistance Professionals or the Alliance of Professional Health Advocates.

Negotiating the medical debt

Once you’ve found and fixed any billing errors, the resulting balance could still hurt worse than the original injury. But you might not have to pay all of it.

If you were hospitalized, ask to speak to an ombudsman, patient advocate or social worker. They could help you get part of your balance forgiven and establish an affordable monthly payment plan for the rest.

If your care was with a doctor or a medical lab, you may have to advocate for yourself. Call the billing department and explain the situation, then ask about ways to reduce the balance.

You may be able to get 5% off the bill by paying with a check instead of a credit card, or be able to “pay in full discount” if you agree to settle up right away versus doing monthly payments. You can also request that any late fees or interest charges be waived.

“Just keep asking,” Bretthauer said.

Getting your debt repaid quickly

Once you’ve finalized the amount to pay, get creative about attacking it. Here are a few potential tactics:

Trim your budget. Temporarily reduce things like dinners out, movies, concerts and sporting events. Drink less coffee and pack more lunches. Put all your extra savings toward the medical debt. (If your budget’s broken, here’s how to fix it.)

Take on more work. If you’re able to take on an extra shift at work, do it. You could also pick up a side hustle to help supplement your income.

If you’re unable to work because you were hurt on the job, you may be entitled to workers’ compensation. Check out our state-by-state guide to see if you qualify.

Sell stuff. Drop off clothing and accessories at a consignment store. List your “Star Wars” collectibles on eBay. Offer up any old furniture on Facebook Marketplace. You’ll pay off your debt that much faster and declutter your living area as an added bonus. Here’s a guide. 

Ask for help. Don’t be afraid to ask a relative or friend to help out. Just make sure you come up with a repayment plan and stick to it. Also consider crowdfunding the medical debt through a site like GoFundMe. There are also some nonprofits, like RIP Medical Debt, that cover the medical debts of millions of Americans.

Avoiding future surprises

You don’t always have the option of getting in-network care. But for planned procedures, get a list of providers from the hospital. If any are out-of-network, ask whether they can be switched for an in-network provider. Double-check any non-hospital care including lab work.

Twenty-eight states now provide partial or complete protection against balance billing. If you live in one of those states and believe you’re getting the runaround from a provider, contact your state’s insurance commissioner for help.

Dealing with medical debt can be frustrating. Unpaid bills can ultimately show up on your credit report and remain for as long as seven years, damaging your credit score. Being proactive will help eventually pay off your debt.

This is just one more reason to have a healthy emergency fund. Here are five things to look for when building one.