This is an excerpt from Dollar Scholar, the Money newsletter where news editor Julia Glum teaches you the modern money lessons you NEED to know. Don't miss the next issue! Sign up at money.com/subscribe and join our community of 160,000+ Scholars.
In a fun twist, I had to get back surgery recently.
Don’t worry, I’m fine! I’m just fully balking at — and mystified by — the process of paying for it. Not only did I have to fork over thousands up front, but when I arrived at the hospital the morning of the procedure, the receptionist said I owed even more due to "an insurance issue." And I suspect additional invoices are on the way.
My experience with medical billing is (thankfully) limited, so I have zero clue how to navigate this. But what I do have is a job as a reporter where I can call up personal finance experts and ask their advice.
What should I do when I get a big medical bill?
The first step is to take a deep breath, says Patrick Haig, the founder and CEO of Goodbill, a hospital bill negotiation service. There’s no need to feel rushed, because I have time to do some research and figure out a plan.
“For most hospitals or heavier-hitting bills, you’re going to have anywhere between 90 and 120 days before you move through their billing cycle,” he says. If there’s a due date printed on my bill, it’s likely an arbitrary one — “they’re probably going to send you another three bills” before taking drastic action, Haig adds.
Even if my debt does go to collections, it’s not going to impact my credit score right away. The three major credit bureaus — Experian, TransUnion and Equifax — observe a 365-day waiting period before putting unpaid medical debt on my credit report. (Under $500, they don’t include it at all.)
I may also want to find out whether my hospital offers a financial assistance program and apply for it. Even if I don’t qualify, Haig says, this can buy me time because it usually freezes the billing cycle.
Next, I should get all of my documents in one place, gathering the bill I received as well as my explanation of benefits, or EOB, which is a letter from my insurer laying out the details of the services I received. Then I can request an itemized bill from the hospital that describes every test, treatment, medication and item I got during my stay.
The last one is crucial because it’ll contain clinical codes, which “are the key to unlocking your understanding of that bill,” Haig says.
From there, I’ll want to compare the papers — am I being billed the same across all the documents? Are the numbers the same on my EOB and itemized bill? If not, I should “talk to whoever’s wrong,” Haig says.
Assuming the sums are consistent, I should start looking more closely at my itemized bill, says Robin Gelburd, president of FAIR Health, a nonprofit that works to bring transparency to health care costs. I need to start looking up those Current Procedural Terminology, or CPT, codes using online resources and matching them to my experience.
Is there anything on the bill that I don’t recognize or remember? Did I get billed for something that never happened?
If everything is correct, I can then check to see if the amounts are reasonable. Gelburd says that costs can vary by geography, which is why FAIR Health has a database where I can input a zip code and CPT and see the typical in- and out-of-network prices for that service, based on a repository of 40 billion private health care claim records.
If there’s a big difference between that number and what’s on my bill, “you can certainly give the medical office a call and try to have that constructive conversation,” she says. “You may not get the relief you seek, but we hear from consumers that there are times when they are given opportunities to amend what's being asked for based on market information they received from our site.”
This method essentially arms me with knowledge, Haig says. When I’m on the phone with the billing department, I can ask for a discount, propose settling the bill for a lower amount if I pay right then or simply request a thorough explanation.
I have a lot of legal rights here, including those provided by the No Surprises Act, a law that took effect in 2022 and protects insured patients from getting huge bills for emergency services and non-emergency services from out-of-network providers at in-network facilities.
“Obviously in the middle of labor, you're not selecting your anesthesiologist” based on whether they’re covered by my insurance company, Gelburd says. “You can seek relief under state no-surprise laws or the federal [one] that allows you to only be held accountable for what would have been the in-network counterpart to that bill.”
Being a jerk to a customer service agent is never the way to go, but Haig says there’s no harm in asking politely to speak to a supervisor or pushing back against what I’m told.
And if a phone call intimidates me or I “call in and find them a bit frosty,” I can ask where to send a letter, “type this all up and position it how you want,” he adds.
There are even options if I’m not quite up to battling over my medical bills. Goodbill is one of several services that will decipher my bills, reviewing them to make sure they’re correctly priced and in line with best practices. (Goodbill doesn't charge a fee up front, but if it’s able to save me money, it takes 15% of whatever the savings were.)
“There's a lot you can do on your own, and there's more you can do with help,” Haig says.
The bottom line
When I get a big medical bill, I should stay calm, know that I have time to figure it out, ask for an itemized version, scrutinize my documents, look up the CPT codes and contact the billing department.
Despite how it might feel, my medical bills are not set in stone. I have the power to advocate for myself.
“These prices are negotiated behind closed doors with consumers basically completely unaware,” Haig says. “When you factor in consumers not really knowing or being able to easily know what everything costs with the sheer magnitude of these prices, it creates some inherent flexibility.”