Reading a medical bill
A medical bill is the start of a conversation, not a final demand. Most large bills can be reduced — by correcting errors, by applying the discounts hospitals are required to offer, and by asking for a plan. Here is how.
Step 1 — Do not pay yet, and do not use a credit card
Paying immediately removes your leverage and may lock in errors. Medical debt has protections that credit-card debt does not. Take a breath and work through the steps below; a bill does not go to collections the day it arrives.
Step 2 — Ask for an itemised bill
The summary you received is not the bill. Ask the billing office for an itemised statement listing every charge with its code. You are entitled to it. If you had insurance, also get the insurer's Explanation of Benefits and compare the two.
Step 3 — Look for the common errors
- Duplicate charges for the same test, drug or supply.
- Services you did not receive — a room type, a procedure, a consultation.
- Wrong codes — a more expensive procedure than the one done.
- 'Unbundled' charges — items that should have been included in a package price billed separately.
- Time errors — operating-room or recovery time longer than actual.
- Insurance not applied or applied to the wrong plan.
Write down every line you question. Call the billing office, ask for a review, and ask for the bill to be placed on hold while the review happens.
Step 4 — Apply for charity care and discounts
California's Hospital Fair Pricing law requires hospitals to offer free or discounted care to uninsured patients, and to insured patients with high medical costs, whose household income is below a set multiple of the federal poverty level — and to tell you about it in a language you understand. Many people are never told.
- Ask the billing office for the financial assistance application (also called charity care or discount payment application).
- You can apply after the bill arrives, and even after it has gone to collections.
- Approval usually wipes out or sharply reduces the bill, and stops collection activity.
- Community health centers charge on a sliding scale and adjust bills to your income on request.
Step 5 — Ask for a payment plan
Hospitals must offer reasonable, interest-free payment plans to eligible patients. Propose an amount you can actually pay each month; a plan that fails is worse than none. Get it in writing.
Step 6 — Know what collections can and cannot do
- A hospital may not send a bill to collections while a financial-assistance application is pending, and must wait a set period after the bill before collection begins.
- Collection agencies must stop calling if you ask in writing, and must verify the debt if you dispute it.
- Medical debt is treated more leniently on credit reports than other debt, and California limits when it can be reported at all.
- Wage garnishment for medical debt requires a court judgment and is limited.
Never ignore a court summons about a medical debt; respond, and contact us.
Step 7 — Prescriptions on the bill
Ask whether the drug price billed matches the cash or generic price; hospital pharmacy prices are often negotiable after the fact when a discount program applies.
How the Foundation helps
- Reviewing the itemised bill with you, line by line.
- Requesting the financial-assistance application and completing it with you.
- Negotiating a payment plan that will hold.
- Responding to collection letters.
- A bridge through the Hardship Fund when an urgent medical cost cannot wait.
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