Hospital bills can be scary, and outstanding medical debt can lead to major problems for patients.
“We’re seeing headlines where hospitals are using aggressive debt collection practices. They're suing folks who can't afford their bills. They're garnishing wages, placing liens on homes,” says Patricia Kelmar, the healthcare campaigns director at US PIRG, a public interest advocacy group. “In some cases,” she adds, “they can even deny care if debts are owed.”
And those are only the most extreme examples. It’s no wonder that in a recent study, nearly two-thirds of patients reported that they had delayed or neglected care because they were worried about the costs. And those costs are steep. An analysis conducted this spring by the Kaiser Family Foundation found that some 23 million adults in the United States have significant outstanding medical debt (more than $250), and 16 million of that group owe more than $1,000. The cumulative total? Some $195 billion.
“Financial toxicity is a medical complication,” says Christi Walsh, the clinical director of research and policy at Johns Hopkins Medicine. She says that many aspects of the billing process — from stress around financing care to the consequences of choosing between paying for a prescription or paying for groceries — can have a direct impact on a patient’s health. “It matters how you treat patients financially, as well as how you treat them clinically,” she adds.
Walsh is part of a team of researchers at Johns Hopkins who worked with The Leapfrog Group, a healthcare nonprofit, to develop a standard for rating ethical billing practices. That standard was used to create Money and Leapfrog’s new list of the Best Hospitals and Surgery Centers for Billing Ethics. You can read more about the methodology, and can also check out Money’s full list of Best Hospitals.
Hospitals that meet the new standard have taken steps to ensure patients are able to easily access and understand what they owe, like listing every service as an individual line item on a bill along with a description of that service. There are also instructions on how to access a copy of a bill in a patient’s primary language as well as instructions for contacting someone who can help them understand the billing process. Hospitals that meet the standard do not take legal actions against patients for unpaid bills.
Walsh says she hopes the new standard can help patients have a better window into the service they’ll receive in a given hospital and also contribute to a nascent discussion in the broader medical community about including a patient’s finances in their holistic care plan.
Of course, it’s not always possible to choose a hospital based or surgery center on billing practices alone. Below are four tips about how to navigate the process.
Be prepared for your bills
Because billing at hospitals can be so confusing and arduous, patients should be as prepared as they can be before they receive care.
For insured patients, Walsh said that starts with having a good understanding of your benefits — even if that means seeking out a family member, friend or healthcare organization who can walk you through your policy. Insured patients should always opt for in-network care, when possible, to make sure they get the most out of their coverage.
If you are uninsured or plan to pay for your care out of pocket, Kelmar says it's important to get a good faith cost estimate before you receive any scheduled care. Under the No Surprises Act, a new law that took effect this year, your hospital is required to provide a breakdown of how much your treatment will cost in advance. If your final bill ends up being $400 or more higher than that estimate, you’re entitled to dispute that bill.
Always contact the billing office
It’s never a bad idea to get in touch with the hospital finance office after you receive your bill. Many people assume that the bottom-line number on a hospital bill is set in stone, but that’s not usually the case: The billing office may be willing to negotiate your bill down.
If that’s not possible, they may be able to set you up with a payment plan or give you a discount for paying in cash. They can also help you figure out if you’re eligible for any financial assistance programs the hospital might offer.
“There usually is something to do to reduce the burden,” says Kranti Rumalla, a research fellow on the team at Johns Hopkins. But be prepared to be persistent — it might take more than one phone call.
Take advantage of community and hospital resources
Some hospitals also have staff — like care coordinators, patient navigators and social workers — who are experts in helping patients navigate the hospital system. It’s a good idea to seek out this support early, especially if you’re looking ahead to a long road of treatment that might come with complex bills.
You can look into other advocacy groups outside of the hospital, like the ones listed here. “There's people out there who can help,” Walsh says.
Don’t transfer your debt away from the hospital
It may be tempting to pay an outstanding medical bill with a credit card or personal loan to satisfy a hospital’s billing department, but Kelmar says that is generally a bad idea.
“The minute you shift the payment and the provider in the hospital is no longer holding that debt,” she says, “you lose a lot of power.” Credit card interest rates tend to be much, much higher than the rate you could negotiate directly with the hospital, and they tend to have high late fees.
There’s also value in keeping your bill classified as “medical debt.” That label could help you become eligible for protections that result from policy changes down the road, like a recent action from the three major credit bureaus that will change how medical debt appears on consumer credit reports, but it disappears if you use a credit card or bank loan to pay your bill.