Confronting a big medical bill? Attack it with a plan -- and these tips

An enormous medical bill can trigger a wave of panic, but try to resist.

That startling invoice that arrived in the mail may not be what patients wind up paying. Errors or slow insurance payments may have inflated the total. Even if it's accurate, financial aid or other assistance might help pare it.

Sometimes a simple phone call clears up a problem. Other times, reinforcements are necessary.

Debt experts say patients should attack medical bills with a plan. Here are key steps to take.

Check the numbers

Medical charges sent to David White are seen June 26 at his home in Temple Hills, Maryland.Jacquelyn Martin ~ Associated Press

Medical charges sent to David White are seen June 26 at his home in Temple Hills, Maryland.Jacquelyn Martin ~ Associated Press

Don't stash the bill in a pile of mail and hope it goes away, but don't rush to pay it without first understanding the amount.

"Especially if it's a really high bill, consider it like an opening offer," said Caitlin Donovan, a spokeswoman for the not-for-profit Patient Advocate Foundation, which helps critically or chronically ill patients deal with debt and insurance problems.

Medical bills can be rife with errors. They also may have been sent before insurance coverage was sorted out.

Donovan recommended comparing the bill with the insurer's explanation of benefits. That's a document the insurer sends explaining how coverage will apply to the care the patient received. It can give a sense for what may still be owed based on the deductible or the plan's out-of-pocket maximum.

If something looks weird, call both the insurer and hospital for an explanation.

David White, who after kidney surgery got hit with a lot of extra charges, next to a poster honoring him as a patient advocate, June 26 at his home in Temple Hills, Maryland. The Patient Advocate Foundation helped him recoup more than $2,000 he paid for routine lab work. "Every single penny that I paid out was refunded," said the 61-year-old White, a volunteer foundation board member. "There's just no way I could figure this out on my own."Jacquelyn Martin ~ Associated Press

David White, who after kidney surgery got hit with a lot of extra charges, next to a poster honoring him as a patient advocate, June 26 at his home in Temple Hills, Maryland. The Patient Advocate Foundation helped him recoup more than $2,000 he paid for routine lab work. "Every single penny that I paid out was refunded," said the 61-year-old White, a volunteer foundation board member. "There's just no way I could figure this out on my own."Jacquelyn Martin ~ Associated Press

Someone at the hospital may have mistakenly entered the wrong code for the care the patient received or duplicated it. Request an itemized bill from the hospital to see whether that happened.

But be aware that those bills also can be hard to interpret or contain errors that have little to do with the charge, Donovan said.

Know the law

The No Surprises Act debuted last year and offers a layer of protection. Patients should check to make sure their care provider is following that law.

It prevents doctors or hospitals in many situations from billing insured patients higher rates when the care providers are not in their insurer's coverage network.

The law offers protection for most emergency care by basically requiring that patients receive in-network coverage with no additional billing from the provider. It also protects patients from huge bills for lab work or an out-of-network anesthesiologist when the patient was treated at an in-network hospital.

The Centers for Medicare and Medicaid Services has established a "No Surprises Help Desk" for people who have questions about whether their bill complies with the law. They can call (800) 985-3059 or submit a complaint online.

Seek outside help

There are a host of for-profit and not-for-profit organizations that can help people navigate medical bills.

The Patient Advocate Foundation helped David White recoup more than $2,000 he paid for routine lab work after his kidney transplant.

A case manager told White that a government database was causing complications with the claim, and this sort of thing had happened before to people with his condition. She also helped him file paperwork to correct the mistake.

"Every single penny that I paid out was refunded," said the 61-year-old White, a volunteer foundation board member. "There's just no way I could figure this out on my own."

The foundation offers an online directory of potential resources for medical or prescription bill help.

Outside help might also include a state attorney general's office, which may have a health advocacy unit or a consumer protection division.

Be very wary of any sort of medical credit card a provider may offer, said John McNamara, a principal assistant director with the federal Consumer Financial Protection Bureau. Those cards may come with high interest rates or terms that can hurt the patient financially if the debt isn't fully paid in a certain time frame.

Plus patients who jump at that offer may miss out on other financial assistance, or their insurer may not be billed, McNamara noted.

Financial assistance

Once you have checked for errors, ask for financial assistance. Some hospital systems may provide help for people with income levels as high as six figures.

"People a lot of times assume they won't qualify," Donovan said.

Patients should be persistent in asking for help or finding out why an application was denied. That may have happened because of a mistake. Applications can ask for a lot of supporting documentation.

Many hospitals don't do a great job letting patients know about available help, said Marceline White, executive director of Economic Action Maryland, a not-for-profit that helps people in that state apply for financial assistance.

"The onus is on the patient to apply for the assistance and do the work," she said.

Ask for a discount if no financial assistance is available.

Bargain and budget

So, the patient has checked for errors and asked about discounts and financial assistance. Now they may have to confront a final invoice.

Ask about a payment plan. Many hospitals will offer options with no interest or a very low rate.

But before committing to that, patients should go over their budget to get a sense for what sort of payment they can handle. Consider looking for income-based programs that may be able to help with rent or utility bills.

Donovan noted people who agree to a monthly bill that turns out to be too high may wind up having that debt land in collections if they can't make payments.

"Then you're in a whole new problem," she said.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Science and Educational Media Group. The AP is solely responsible for all content.