How can I pay off my medical bills?

If you have unpaid medical bills, you’re not alone!

Unexpected trips to the emergency room, chronic conditions, and other medical needs can quickly add up to an overwhelming amount of medical bills and expenses. Even with insurance, it’s not uncommon to go into debt from medical expenses. In fact, over half of Americans have medical debt, and the number is even higher among parents.

Medical debt can feel crippling, but you have options. This module covers steps you can take to eliminate and prevent medical debt, including special resources available to survivors of domestic abuse. Sections in this module include:

• What is medical debt
• Dealing with medical debt
• Minimizing medical debt
• Seeking emotional support & prioritizing self-care

What is medical debt

Medical debt happens when you receive medical treatment and you can’t afford to pay the bill right away. Hospitals often send bills weeks or months after you have been treated, and bills are often a lot higher than expected. Many people are not prepared to pay the full amount and end up owing the hospital money. 

Dealing with medical debt

First of all: don’t panic. You have time to figure this out. In 2022, credit bureaus adopted several new protections that help prevent medical debt, paid or unpaid, from affecting your credit. For example, medical debt can not be reported to credit bureaus until one year after you are billed. Whether you’ve just received an unpayable medical bill or have medical debt in collections, know you have options.

1. See if you qualify for charity care or other financial relief

If you are struggling with medical debt, financial assistance can make a huge difference in how much you have to pay and how soon you have to pay it. All non-profit hospitals in the US are required to provide some form of financial assistance, and most for-profit hospitals have similar programs. At non-profit hospitals, which make up a bit more than half of all US hospitals, this program is known as charity care.

Charity care can pay back part or all of your medical bills if you prove that the medical care was necessary and/or that you don’t have enough income to pay the bill yourself. The requirements to qualify for charity care vary by state and by hospital, so it is always worth checking whether you qualify. Click here to use Dollar For’s free and easy to use tool to find out whether you qualify for charity care. If you qualify, Dollar For can also help you apply online to receive charity care from your hospital. If you don’t want to use an online application, you can always contact your medical provider directly and ask for help applying for charity care.

If you received medical treatment from a for-profit hospital, check their website for private financial assistance programs.

Many hospitals and healthcare providers also offer financial assistance programs specifically designed for survivors of domestic abuse. The availability of public and private financial assistance varies depending on your income and state. If you feel comfortable, reach out to your current insurance and/or hospital and ask about any programs they may have to assist survivors of domestic abuse.‍

2. Check if you’re being overcharged

Medical billing is a very complicated process, and hospitals and insurance companies often make mistakes. Estimates vary, but it is possible that up to 80 percent of medical bills contain errors.

Here are some steps to follow to make sure your bills are correct and not overcharging you:

1. Ask the hospital for an itemized bill, which provides a line-by-line description of the services you’re being charged for. This bill should have more details than the billing summary most hospitals provide by default. 
2. Check the itemized bill for duplicate charges, charges for services not received, and inflated prices. To see if you’re being overcharged, you can use resources like Turquoise Health.
3. If you have insurance, make sure it was applied to your bill. You may need to request an “explanation of benefits” from your insurance provider to make sure all of your benefits were accurately applied.

If you do find a mistake or unfair pricing, you can file a dispute. See the next section (3) to learn about how to negotiate changes to your bill.‍

3. Consider negotiating prices with healthcare providers

It is terrifying to be presented with a large hospital bill and a payment deadline that you know you cannot meet. Fortunately, most people who try are able to adapt their bill amounts and payment schedules to fit their needs by discussing the issue with their healthcare providers or insurance companies.

Negotiating with insurance companies and hospitals is actually one of the most effective ways of reducing medical debt. Negotiating on your own can be scary, but it is absolutely worth trying.

Here’s how to negotiate:

1. Make sure your bill is correct. Follow the steps in the above section (2) before moving on.
2. If you can afford to pay some of your bill now, ask the hospital for a “settlement amount,” which is the percentage of your total bill they would take if you were to pay it right away. The settlement amount should be around 50 to 70 percent of the total bill. If it is too high, call back another day and try again.
3. If up-front payment doesn’t work for you, ask the hospital if you can go on a payment plan, or pay in increments. You may have to pay interest, but it should be lower than taking out a loan. Sometimes, medical providers will even write off the rest of your bill if you pay on time for long enough.

Check out this NPR podcast or youtube video for more information on negotiating medical debt. If you are contacted by a debt collector, check out this guide and learn about your rights. ‍

4. Know your legal options for economic justice:

Medical costs are exceedingly high in the US, and it can feel incredibly unfair to end up in debt just because you needed medical treatment, especially if your medical bills are the result of abuse. Fortunately, you have legal options to get reimbursement from your harm-doer. 

Pursuing economic justice generally requires documentation in the form of a police report. If you do not feel comfortable involving the police, that is okay, and you are not alone.

However, if you do decide to take official legal action against an abuser there are many resources available:

• If you already have medical debt due to domestic violence, it may be possible to sue your abuser for medical expenses. You will need to go to small claims court and prove a connection between your medical bills and the person you are suing. 
• Some states can pay you back for your medical bills through the National Association of Crime Victim Compensation Boards reimbursement program. Click here to apply for victim compensation–just select your state and follow the links to apply online or by mail, depending on state.
• You can also qualify to be reimbursed if you file a restraining order against an abuser.
• Women’sLaw.Org has a tool that can help you figure out next steps for all three of the above options, and you can customize the results by state.

Minimizing medical debt

Whether you have medical debt already or not, taking steps to prevent debt can be a great way to protect yourself financially.

Getting good insurance is the best way to minimize medical debt. The US government provides insurance to low-income individuals and people dealing with challenging circumstances such as abuse, unemployment, unsupported pregnancy, and more. This program is called the Affordable Care Act, or ACA.

Under the Affordable Care Act, survivors of domestic violence are entitled to healthcare protections. This includes protection from discrimination by insurance companies and the right to receive free or low-cost services related to domestic violence.

No legal or medical proof is needed to access the special ACA enrollment for survivors. Special enrollment allows you to apply for insurance at any time, outside of the limited yearly enrollment period.

Here are some specific benefits provided by the ACA:

• The ACA can provide health insurance or financial assistance to survivors who previously relied on a spouse’s insurance policy. Click here to check if you qualify for a special enrollment period.
• The government provides coverage to children who are dependent on the primary policy holder. Learn more here.
• For survivors living in a shelter or other temporary housing, the ACA allows the use of a temporary address on insurance applications. 
• Futures Without Violence has more information on protections from the ACA.

Seeking emotional support & prioritizing self-care

Dealing with medical debt can be exhausting and an unwelcome reminder of something painful you went through. Consider asking someone in your circle of trust to support you, whether it’s calling the hospital billing office on your behalf, analyzing bills for you, or helping you with self-care.

You also have the option to talk to a domestic abuse advocate, who may be a great source of support navigating your journey to financial security and safety. There are many trauma-informed advocate services available, which you can find using this search tool.