If You Have a Hospital Bill You Cannot Pay, Here Is What to Do First
A hospital bill is different from most other bills. The amount is often larger, it arrives when you are already dealing with a health crisis, and the options for reducing or eliminating what you owe are more substantial than most people know. Nonprofit hospitals — which cover the majority of hospitals in the United States — are required by federal law to offer financial assistance to patients who cannot afford their bills. For low to moderate income households, that can mean a significant reduction or a full write-off. You have to ask for it, but it is there.
Learn about the main options for people dealing with a hospital bill they cannot pay — from financial assistance programs the hospital itself must offer, to government coverage that can apply retroactively, to outside help if the bill has already gone to collections. If your bill has aged past the point where it is now being pursued by a collections agency, the page of what you can do with medical debt covers what changes and what options remain.
Start with the hospital's own financial assistance program.
Every nonprofit hospital is required under federal law to have a charity care or financial assistance program and to make it available to patients who qualify. The income thresholds vary by hospital, but on average patients below roughly 200 to 300 percent of the Federal Poverty Level qualify for free care or a significant discount. Some hospitals extend discounts further than that.
You will not be told about this automatically. You need to call the hospital billing department and ask specifically for a charity care or financial assistance application. If the hospital's bill has already been sent to a collections agency, call the hospital billing department directly — not the collector — and ask whether you can still apply. Federal law gives patients up to 240 days from the first billing statement to apply, and the hospital must pull the account from collections while your application is under review.
The hospital charity care guide to applying covers how these programs work, what income thresholds typically look like, what to do if you are denied, and how to apply even if a bill has gone to collections. The nonprofit Dollar For at https://dollarfor.org/ helps patients navigate these applications at no cost. If you have not checked charity care yet, do that before anything else on this page.
For state-specific hospital assistance programs, the hospital bill assistance programs directory has links to many states with their own resources and requirements.
Check your bill for errors before you pay anything.
Hospital billing errors are common — duplicate charges, services billed that were not provided, room charges for days you had already been discharged. You are not going to spot these on the summary statement the hospital typically mails. Ask for an itemized bill, which lists every charge individually, and compare it against your insurance explanation of benefits if you have one. If something looks wrong, dispute it in writing. The hospital must pause collections on any charge that is under active dispute.
A medical billing advocate can do this review for you and typically charges only if they successfully reduce your bill. More on medical billing advocates. For guidance on finding errors yourself, the guide to medical billing errors page walks through what to look for.
Check whether your bill involves a surprise or out-of-network charge
If you received emergency care or had a procedure at an in-network facility where some providers — an anesthesiologist, a radiologist, an assistant surgeon — turned out to be out-of-network, you may have protections under the No Surprises Act that limit what you can be charged. Learn what the No-Surprises Act does to prevent billing.
Government coverage that can apply to past hospital bills
If you are uninsured or recently lost coverage, Medicaid may be able to cover hospital bills retroactively — in most states, up to three months before your application date. You need to ask specifically for retroactive coverage when you apply; it is not automatic. Apply through your state Medicaid office or at https://www.medicaid.gov/. Even if you were denied Medicaid in the past, a change in income or a new disability may mean you qualify now.
For seniors and people on Medicare with questions about a hospital bill, the Medicare helpline at 1-800-633-4227 can review claims, identify errors, and explain your coverage and appeal rights. The main Medicare contact page is at https://www.medicare.gov/about-us/contact-medicare.
Negotiate a payment plan directly with the hospital.
If charity care does not fully cover the bill and you still owe a balance, most hospitals will set up a payment plan. Interest-free payment plans are common and sometimes required by state law for patients below certain income levels. Ask for one before the account moves to collections, because your options narrow once it does. Get any payment plan agreement in writing before your first payment. If the agreed amount is still more than you can manage, a [medical billing advocate may help with that as well. Or a local or national nonprofit credit counselor.
If the bill has already gone to collections
Going to collections does not mean your options are gone. You can still apply for charity care if the 240-day window is open. You may be able to negotiate a settlement for less than the full balance. And collectors are subject to legal limits on how they can contact you and what they can do to collect. The medical debt settlement page covers negotiating a reduced payoff. The medical debt collection laws page.
If you need outside help
A nonprofit credit counselor can review your full financial situation, help you prioritize, and negotiate with providers on your behalf at no cost or very low cost. The National Foundation for Credit Counseling at nfcc.org has member agencies in most states. Learn more about free or income-based nonprofit credit counselors.
If you are being sued over a hospital bill or facing a garnishment threat, free legal aid is available in most states through nonprofit legal services organizations. Get additional details about free legal advice for debt situations
For people who need ongoing medical care and cannot afford it, the directory of free and low-cost clinics by area provide care on a sliding scale regardless of insurance status.
Disclaimer: This page provides general educational information about options for people dealing with hospital bills. It is not legal, medical or financial advice. Program eligibility, income thresholds, and state laws vary. For guidance specific to your situation, contact a nonprofit credit counselor or a legal aid organization in your state.
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