Read Part 2 of this series: Medical Debt Part 2: Enrolling in a financial assistance program (charity care).
Download a printable version of this post.
Do you have medical or dental bills that…
- …are past due?
- …you are unable to pay?
- …you are paying off over time to a hospital or medical provider (a payment plan)?
- …have gone to a collections agency?
- …you paid for by borrowing money from a bank or other lender that you now are paying back?
- …you put on a credit card and are paying off over time?
If you answered yes to any of the above, this is considered medical debt. Medical debt is very common in the United States: around 4 in 10 people reported some type of medical debt in 2022. Unexpected medical emergencies – or even routine healthcare services and prescriptions – may be expensive, especially for people who are uninsured or underinsured.
This is the first blog post in a series on medical debt. It will walk you through some things to consider when you receive a medical bill.
The Washtenaw Health Project is here to help you navigate medical bills, medical debt, health insurance, and financial assistance programs! Make an appointment by calling 734-544-3030 or emailing us at whp@washtenaw.org.
Step 1: Figure out whether you need to pay the bill you’ve been given
Take a close look at the bill you received. Is it your name on the bill? Did you actually receive medical care on the dates listed? Do you recognize the medical services that the bill is asking you to pay for?
Hospital systems and billers make mistakes all the time. They may charge you for a service you didn’t receive, charge you twice for the same service, or bill you incorrectly in some other way. It’s a good idea to always request an itemized bill from your healthcare provider before you pay any bill. You can also check the billing section of MyChart or another healthcare app to view or generate an itemized bill. An itemized bill lists exactly which services you are being charged for. If anything is incorrect, you can dispute the charges with your medical provider to lower the cost of your bill.
View more information on how to read an itemized bill here and here.
Have you already paid this bill? Has your insurance company paid their portion yet?
Check to make sure you or your insurance plan haven’t already paid this bill. A repeat bill may have been sent to you after you paid the bill but before your payment was processed.
You should also check to make sure your insurance company has paid their portion of the bill. Your healthcare provider may have sent you a bill before it went through insurance. Wait until your insurance company processes the claim and covers their portion of the charges before you pay the bill.
Step 2: Ask yourself about health insurance
I have health insurance
Did your health insurance plan cover services correctly?
Your health insurance plan should provide you with an Explanation of Benefits (EOB) either through your online health insurance account or by mail. You can also call the number on the back of your insurance card to request an EOB.
An EOB is a breakdown of the cost of each service you received, how much the insurance plan is paying, and the amount you owe to the medical provider (if anything). It is NOT a bill. When you receive an EOB, you should check to make sure that it matches any bills you received from a medical provider. If it doesn’t, or your EOB looks incorrect in some way, you should contact your health insurance plan and/or your medical provider to resolve any discrepancies.
View a guide to reading an EOB here.
Is this an unexpected bill related to an emergency room visit?[MB1]
Under the No Surprises Act, most people with health insurance from their employer, the Marketplace, or that they purchased directly from a health insurance company are protected from unexpected out-of-network bills related to emergency care and some out-of-network services provided at in-network facilities. These services must be billed to you at in-network rates – you can dispute bills that are not.
View more information on which healthcare services are covered under the No Suprises Act and how to submit a complaint here.
Could I qualify for financial assistance?
If your healthcare costs are too high even with insurance, read about financial assistance programs below!
I do NOT have insurance
Would you qualify for Medicaid?
If you are uninsured, you may qualify for Medicaid. Medicaid may act retroactively to help cover medical bills for services you received in the past. You will need to act quickly – Medicaid will only cover back a certain number of months.
View more information on types of Medicaid and how to apply here.
The Washtenaw Health Project is here to help you determine if you qualify for Medicaid and help you apply! Make an appointment by calling 734-544-3030 or emailing us at whp@washtenaw.org.
If you do not qualify for Medicaid or have bills from medical care you received during a gap in coverage, read about financial assistance programs below!
Is the amount you’re being charged more than the good faith estimate?
If you are uninsured, your medical provider should provide you with a “good faith estimate” before your appointment (as long as you scheduled your appointment at least three business days in advance) – you can request an estimate if they did not provide one. A good faith estimate lists the expected amount you will be charged for services. If your bill is more than $400 higher than your good faith estimate, you can dispute it.
View more information on good faith estimates and how to dispute a bill here.
Step 3: Consider financial assistance programs or charity care
What are financial assistance programs (charity care)?
Financial assistance programs – sometimes called “charity care” – are hospital-run programs that offer discounts or complete forgiveness of hospital bills for medically necessary healthcare. Depending on the program, financial assistance can cover both unpaid bills from previous medical care and healthcare bills going forward for a specified period of time.
How can financial assistance be applied?
Financial assistance will NOT be approved in all situations. Common costs that are covered by financial assistance include:
- Costs that employer-based, private, or other insurance don’t cover, including copays, deductibles, coinsurance, etc.
- Costs associated with medical care not covered by health insurance
- All costs associated with medical care during temporary periods of uninsurance
- Prescription costs (sometimes)
Financial assistance programs will not usually cover the costs of care for ongoing and prolonged periods where you do not have insurance. They should cover periods when you have lost coverage but have not yet enrolled in another plan.
Which healthcare systems offer financial assistance?
All non-profit hospitals are required by the federal government to offer financial assistance. For-profit health systems may also offer financial assistance. In Washtenaw County, both the University of Michigan Health System (Michigan Medicine) and Trinity Health have financial assistance programs.
Who qualifies for financial assistance?
Each hospital system sets their own eligibility criteria for their financial assistance program, often based on income, insurance status, assets, and other factors.
In the next blog post, we will walk you through applying for charity care at Michigan Medicine and Trinity Health! The Washtenaw Health Project can also help you with your application. Make an appointment by calling 734-544-3030 or emailing us at whp@washtenaw.org.
Step 4: Consider a payment plan to pay your bill over time
Everything we have covered so far is about finding ways to reduce the cost of your medical bill. If, after the above steps, you still have a balance that you are unable to pay, you can ask about a payment plan. Hospital systems and medical providers are often willing to set up short- or long-term payment plans for you to pay the money you owe over time (often without accruing interest!). Contact your provider’s billing department to discuss payment plans.
If you call your healthcare provider’s billing department, the first thing they might offer you is a payment plan. Remember to ask about and apply for financial assistance before you accept a payment plan!
Step 5: What if my medical debt has gone to collections?
Healthcare providers may contract with or sell your medical debt to third-party debt collectors. Debt collectors may aggressively pursue payment from you or try to pressure you into paying. If your medical debt has gone to collections, you still have options! Check out the resources below to learn more about medical debt collections.
An Arm and a Leg – Medical Debt Collections Toolkit
Consumer Financial Protection Bureau – What should I know about debt collection and credit reporting if my medical bill was sent to collections?
Want to know more? Check out these resources!
Medical Debt Part 2: Enrolling in a financial assistance program (charity care).
A helpful flow chart outlining the steps talked about in this blog post.
A how-to guide for reading medical bills.
More information on explanations of benefits.
Information on Michigan Medicine MSupport (financial assistance program).
Information on Trinity Health’s financial assistance program.
A starter pack of information and guidance for navigating medical debt.
More in-depth information and statistics about the burden of medical debt in the United States.