How to Get Help Paying Medical Bills—Even If You Have Insurance

Why You Might Still Struggle with Medical Bills—Even If You’re Insured

Insurance isn’t a silver bullet when it comes to healthcare costs. In fact, a 2022 survey from the Kaiser Family Foundation found that about 4 in 10 insured adults reported problems paying medical bills or managing debt due to healthcare expenses.

Some common reasons include:

• High deductibles: Many plans require you to pay $1,000–$7,000+ before insurance even kicks in.

• Out-of-network providers: If a doctor or hospital isn’t in your plan’s network, you could be billed the full amount or face higher cost-sharing.

• Emergency services: Even if you go to an in-network hospital, you might be treated by out-of-network providers like anesthesiologists or radiologists.

• Balance billing: When the provider bills you for the difference between what they charge and what your insurer pays—though this is now largely banned for many services under the No Surprises Act.

So what can you do if you’ve received a big bill you can’t afford? There are more options than you might think.

Ask About Hospital Financial Assistance Programs

One of the most overlooked resources is the financial assistance or charity care program offered by most hospitals and nonprofit health systems.

Under the Affordable Care Act, nonprofit hospitals are required to:

• Offer financial assistance policies (FAPs)

• Publicly post eligibility criteria

• Make application forms accessible

These programs aren’t just for the uninsured. Many offer sliding scale discounts or partial forgiveness of bills for insured patients who meet income thresholds.

For example:

• A hospital may forgive 100% of your bill if your income is below 200% of the Federal Poverty Level (FPL).

• You might get a 50–75% discount if your income falls between 200% and 400% of the FPL—even if you have insurance.

What to do:

• Ask the hospital billing office for a copy of their Financial Assistance Policy.

• Request and submit an application—typically requires proof of income, household size, and insurance info.

• Apply as soon as possible, ideally before the bill goes to collections.

Even if you think you earn too much to qualify, it’s worth asking. Some hospitals consider high out-of-pocket costs in relation to your income rather than just your income alone.

Request an Itemized Bill and Review It for Errors

Before you pay a large medical bill, ask for an itemized bill—a detailed list of all services and charges. Billing errors are surprisingly common and can significantly inflate your costs.

Look for:

• Duplicate charges

• Incorrect quantities (e.g., being charged for 3 injections when you only received 1)

• Unbundled services (charged separately when they should be grouped)

• Out-of-network charges for in-network care

If something doesn’t make sense, call the billing department and ask for a corrected bill. You can also request a copy of the Explanation of Benefits (EOB) from your insurance provider to compare what was covered versus what’s being billed.

Don’t assume the hospital or doctor’s office always gets it right—catching even one error can save you hundreds of dollars.

Negotiate Directly With the Billing Department

Yes, you can negotiate medical bills—even after insurance pays. Many hospitals and private providers are willing to reduce costs for insured patients facing financial hardship or high balances.

Tips for negotiating:

• Be polite but firm. Explain your financial situation and ask what options are available.

• Ask about prompt pay discounts (some providers offer 10–20% off if you pay quickly).

• Offer to pay a reduced amount in a lump sum (if you have access to savings or help from a friend/family member).

• Mention that you’re willing to apply for financial assistance or seek third-party help.

Document everything and get any agreement in writing. If the billing department agrees to reduce your bill, ask for a new invoice showing the adjusted amount before you make payment.

Set Up an Interest-Free Payment Plan

If you can’t pay your balance all at once, most hospitals and medical offices will work with you to set up a monthly payment plan—often interest-free.

Be proactive. Instead of putting the bill on a credit card (which adds interest and can damage your credit if you miss payments), call the provider and ask:

• What’s the lowest monthly amount they’ll accept?

• Can they spread it out over 12 months or longer?

• Will they stop collections activity while you’re on the plan?

This option won’t reduce your total balance, but it can give you time to pay without additional fees or damage to your credit.

Use a Medical Billing Advocate

If you’re dealing with multiple bills, complex procedures, or insurance disputes, a medical billing advocate can help. These professionals specialize in reviewing medical bills, finding errors, negotiating with providers, and dealing with insurance companies.

Billing advocates are especially helpful if:

• You’ve received surprise bills or out-of-network charges

• Your insurance has denied claims you believe should be covered

• You’ve already tried negotiating and gotten nowhere

Some advocates charge a flat fee, while others take a percentage of the money they save you. In general, they can save you time, stress, and—most importantly—money.

To find a reputable advocate, check:

• Medical Billing Advocates of America

• National Association of Healthcare Advocacy

• Your state insurance department or consumer protection agency

Look Into State and Local Assistance Programs

In addition to hospital-based programs, your state or local government may offer support with medical bills—even for insured residents.

Some programs include:

• State-sponsored high-risk pools (for people with chronic conditions and high expenses)

• Temporary medical hardship grants

• Local nonprofits that help residents with utilities, food, and health expenses

• Community health centers that offer sliding-scale services based on income

Use 211.org or call 2-1-1 from your phone to get connected to local assistance programs in your area.

Use HSA or FSA Funds—Even After the Bill Is Due

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can use those pre-tax dollars to pay off medical bills—even retroactively, as long as the expense was incurred while the account was active.

You don’t need to have the money in the account at the time of service—just when you’re ready to pay the bill. This is an often-overlooked strategy for managing medical debt while saving on taxes.

Just make sure to keep all receipts and records in case you need to prove the expense was qualified.

Appeal Insurance Denials

Sometimes, the problem isn’t the bill—it’s your insurance company denying coverage for a procedure, medication, or provider. If this happens, you have the right to file an appeal.

Start by:

• Reviewing your Explanation of Benefits (EOB)

• Asking your provider to write a letter of medical necessity

• Contacting your insurer to request a formal appeal

Under ACA rules, you’re entitled to both:

• An internal appeal through your insurer

• An external review by an independent third party if the internal appeal is denied

You usually have 180 days from the date of the denial to begin the appeal. If successful, your insurance may be required to pay the claim—eliminating the bill or reducing your responsibility.

Avoid Medical Debt Going to Collections

If you can’t pay a bill right away, the worst thing you can do is ignore it. Once a medical bill is sent to collections, it can damage your credit—though recent changes have made the impact less severe.

Here’s what to know:

• The three major credit bureaus (Equifax, Experian, and TransUnion) now give consumers one full year before unpaid medical debt appears on credit reports.

• Medical debts under $500 are no longer included in credit reports at all.

• Paid-off medical collections are removed entirely from credit reports.

Still, letting a bill go to collections is risky. It can lead to court judgments, wage garnishment, and long-term financial problems. Reach out early to your provider to explore payment plans or financial assistance options.

You Don’t Have to Handle It Alone

Medical bills can be confusing, stressful, and often feel unfair—especially when you’ve already done your part by having insurance. But remember: you’re not stuck. Whether it’s financial aid from the hospital, negotiation tactics, or professional advocates, you have multiple tools at your disposal.

Take the first step by reviewing your bill closely, asking questions, and seeking out the support systems that exist to help people just like you. The healthcare system isn’t easy to navigate—but that doesn’t mean you have to face it on your own.