Last year, Ted got hit with a surprise $2,700 bill after a work-related ER visit. When he missed a follow-up call from a collections agency, the bill ballooned to nearly $3,000.
Now, he’s getting nonstop calls from debt collectors and doesn’t know what to do.
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Ted, 53, is one of millions of Americans dealing with medical debt. The most recent Census Bureau Survey of Income and Program Participation (SIPP) found that 15% of households owed medical debt in 2021.
A 2021 Kaiser Family Foundation (KFF) poll, which used a broader definition of medical debt that included credit card charges and money owed to family members, found that 41% of American adults carried some form of medical debt.
KFF’s analysis of the SIPP report showed that about 6% of U.S. adults — 14 million people — owe more than $1,000. Around 2% (6 million people) owe more than $5,000, and 1% (3 million people) owe more than $10,000 in medical debt.
Know your rights
Ted’s first step is to make sure that his bill is legal. He’s insured through work, so under the No Surprises Act, he shouldn’t be charged more for an out-of-network ER visit than he would be for an in-network one.
While that may not apply to Ted’s case specifically, the law also protects against surprise bills for non-emergency, out-of-network care related to certain in-network visits and air ambulance services. If you’re unsure about a bill, you can call the No Surprises Help Desk run by the Centers for Medicare & Medicaid Services.
If you don’t use insurance — either because you don’t have any or choose not to — and you book your appointment at least three business days in advance, providers are typically required to give you a written good-faith estimate of expected charges. This should include facility and hospital fees.
If the provider doesn’t automatically give you the estimate, ask for it. If your care involves multiple providers, you’ll need separate estimates from each one.
If your final bill is $400 or more above the estimate, you can dispute it through the Centers for Medicare & Medicaid Services. While the dispute is being reviewed, the provider can’t initiate collections — and if the bill has already been sent to collections, that process must be paused during the dispute.
If a debt collector contacts you about an out-of-network or surprise medical bill, you can file a complaint with the Consumer Financial Protection Bureau (CFPB) online or by calling 1-855-411-2372.
You should also contact the CFPB if a medical charge appears on your credit report. As of July 1, 2022, paid medical collection debt and debt under $500 shouldn’t show up on credit reports. Unpaid medical debt must be at least a year old before it appears.
Debt collectors also have specific rules about how and when they can contact you, outlined in the CFPB’s Debt Collection Rule.
Ted should go over his bill to make sure it reflects the care he actually received. He should check for duplicate charges or errors. If anything looks unusual or he has questions, he should call the hospital’s billing department for clarification.
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Try negotiating and seek help
Once you’ve reviewed your bill, you may be able to negotiate a lower amount or set up a payment plan with the hospital. Some providers even offer a discount if you pay promptly. But it’s important to act before the bill goes to collections. At that point, you’ll have to deal with the collections agency — which means it’s already too late for Ted to negotiate with the hospital directly.
If the bill is large, you might consider working with a medical bill negotiator who can try to lower the amount on your behalf.
If you’re uninsured or underinsured, you may qualify for financial help through the hospital. The Affordable Care Act (ACA) requires hospitals to have a written Financial Assistance Policy (FAP) and an Emergency Medical Care policy. These programs may allow you to get free or reduced-cost care. You’ll need to fill out an application and provide financial documents, but you can ask debt collectors to pause collection efforts while your application is under review.
Several charities and government programs also offer support for medical debt, travel expenses and medical equipment. You may want to work with a patient advocate who can help you navigate the health care system, understand your bill and find assistance.
Ted’s story underscores one key lesson: Don’t wait. It takes time to apply for help and get approved, and you’ll want to set up a payment plan before the account is sent to collections.
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This article provides information only and should not be construed as advice. It is provided without warranty of any kind.
