What to Do When a Medical Bill Arrives and You’re Not Prepared

If you receive a medical bill you weren’t expecting, your first instinct may be to pay it as quickly as possible and move on. But before you do, pause and consider your options. You may be able to dispute billing errors or ask about financial assistance. 

If you can’t cover the bill right away, another option is to apply for a personal loan and help spread out the cost over time. Here’s how to approach a medical bill before paying it.

Review the bill before you pay it

Start by comparing your bill line by line with the Explanation of Benefits (EOB) you received from your insurance company.

Check that:

• Your name and date of service on the bill are accurate
• The listed services match what you actually received
• The amount your insurance paid is accurate, including your deductible, copay or coinsurance
• Each provider is listed correctly as in-network or out-of-network (this affects what you owe)
• Your bill doesn’t include duplicate charges or services you haven’t received

Keep copies of every bill, letter, and note from phone calls with your provider or insurer. You’ll want a paper trail if you need to dispute anything later.

Find out why the bill is higher than expected

When a bill is larger than anticipated, identifying the reason can help you understand what happened.

Reasons your bill may be higher than expected include:

• Your insurer denied the claim
• You haven’t met your deductible yet, so you’re responsible for more of the cost
• Your provider was classified as out-of-network
• The service was billed incorrectly
• You received separate bills from different providers involved in the same visit, such as an anesthesiologist or a lab

Call your insurer and your provider’s billing office to ask exactly why the amount is what it is. If your claim was denied and you disagree, most plans offer an appeal process to dispute the denial.

Check whether the bill can be disputed

Aside from billing errors, federal protections may apply to your situation. Under the No Surprises Act, you may receive protection from certain unexpected bills tied to emergency care or out-of-network providers at in-network facilities.¹

As part of this same federal law, if you’re uninsured or paying out of pocket, providers must give you a good-faith estimate of your expected costs before treatment.² 

If your final bill is at least $400 more than that estimate, you can use the Centers for Medicare and Medicaid Services’ patient-provider dispute resolution process to challenge the charges. ³ 

To qualify, your initial bill must be dated within the last 120 days, and you may need to pay a $25 administrative fee to start the dispute.⁴

Ask about financial assistance or a lower bill

Many hospitals and providers offer charity care, discounts, or hardship programs for patients who qualify. It never hurts to ask, even if you’re not sure you’ll be eligible.

Some providers also offer interest-free payment plans that let you pay over time without extra cost. If you’re offered any kind of assistance or payment arrangement, get it in writing before you agree to it. 

Know what to do if the bill goes to collections

If your bill ends up with a collection agency, you still have rights. Start by verifying that the collection claim is accurate and that the agency is legitimate before you pay anything.

The Consumer Financial Protection Bureau is a helpful resource if you believe a debt collector is acting improperly or if the amount doesn’t match your records. 

Keep every piece of documentation from your dispute, including dates, names, and copies of any letters you send or receive.

A simple medical bill action plan

If you’re not sure where to start, use this quick checklist:

• Compare your bill against your EOB, line by line
• Verify every charge, date and provider listed
• Question anything that looks unfamiliar or duplicated
• Check if federal or state protections apply to your bill
• Ask about financial assistance or a payment plan
• Document every call, letter and conversation

Pause before you pay for a medical bill

An unexpected medical bill doesn’t have to control your finances. Verify what you owe, challenge anything that looks wrong, and understand the rights you have under federal law. 

When you need extra support, the Centers for Medicare and Medicaid Services and the Consumer Financial Protection Bureau are both helpful resources to turn to for guidance.