Can’t Afford to Pay Your Medical Bills? Here’s What Happens Next

Did you know that one of the main reasons people file for bankruptcy is because they are buried in medical bills?

The 2020 SIPP survey suggests Americans’ collective medical debt totaled at least $195 billion in 2019. According to a Forbes report, half of Americans now carry medical debt, up from 46% in 2020. That comes as no surprise, given that it can cost up to $20,000 to have a baby.

What Happens if I Don’t Pay My Medical Bills?

Defaulting on any debt can have serious consequences. Medical debt is handled a little differently than other types of consumer debt. Since most health care providers don’t report to credit bureaus, your medical debt would have to be sold to a collection agency before it can appear on your credit report.

The health care provider will eventually sell the debt to a collection agency at 30, 60, 90,120, or even after180 days.

You have one a year before your unpaid medical bills are sent to collections as of July. Once that happens, though, expect phone calls from debt collectors to start. But if your medical debt is under $500, it won’t even be on your credit report.

You have some rights, though: The Fair Debt Collection Practices Act regulates how — and even where — debt collectors can contact you.

Don’t assume partial payments will keep your debt from being handed over to the debt collector. Medical bills don’t usually have minimum charges, and you’re generally expected to pay a lump sum. You will need to negotiate a payment plan with your provider.

Medical Debt Collection is Different

Unpaid medical debt is different from credit card debt. Patients get more leeway because it takes time to work out issues with the insurance plan and healthcare provider. 

Think Twice Before Using a Credit Card

According to the Federal Department of Health and Human Services, medical debt is currently capped at an interest rate of 9 3/8%, so using a credit card or personal loan with a higher interest rate doesn’t make sense unless you’re eligible for an ultra-low-interest promotional offer. Negotiate a payment plan instead.

How to Get Help if You Can’t Pay Medical Bills

There are some community programs and organizations that might be able to help you, but here are some steps you can take to address your debt problem.

Do You Qualify for Financial Assistance?

Many nonprofit organizations can help with medical expenses. Investigate nonprofit organizations that serve your community. 

Here’s a list of 9 government programs that can help you. Eligibility requirements will vary by state, age, income, household, residency status, and disability.

  • Medicare
  • Medicaid
  • Extra Help
  • Supplemental Security Income
  • Health Insurance Marketplace
  • Children’s Health Insurance Program
  • HealthWell Foundation
  • Patient Access Network Foundation
  • Patient Advocate Foundation

Apply for a Loan

Loans and credit cards should be considered a last resort, but there are times when they’re necessary. Only go this route if you have high medical bills and can’t set up a payment plan or get financial assistance elsewhere.

Work With Any Debt Collection Agencies That Contact You

Be honest with the debt collection agency. Accounts in collections can severely damage your credit for years to come. If a debt collection agency is contacting you, don’t ignore them. You may be able to negotiate a settlement.

Carefully Review All Charges

Review all hospital bills and anything from secondary medical providers for errors, and compare them with coverage paperwork from insurers.

Look for incorrect charges or anything that doesn’t look right. Ask for an itemized bill. If something seems off, question it. You can even check with your company’s HR department for help.

One man in Texas went to a free-standing ER for a COVID test. He was charged more than $50,000. After disputing the charges, his insurance company ended up covering the bill.

Question everything: In a more recent example, a woman was billed $2,185 for a routine colonoscopy that was supposed to be fully covered under the Affordable Care Act. The reason for the bill? Noncancerous polyps were removed during a previous colonoscopy (which is extremely common), so five years later, the medical facility coded her next procedure as diagnostic instead of preventive. While preventive procedures must be covered in full due to provisions in the Affordable Care Act, diagnostic procedures are subject to your insurers’ deductibles.

Do you Qualify for Payment Assistance Programs or Charity Care?

Charity care in health care provides free or discounted medical care to people who can’t afford to pay. It includes both inpatient and emergency room services. Even if you have health insurance, you may qualify for charity care to pay the amount of your hospital bill that your insurance doesn’t cover. Nonprofit hospitals must offer charity care to maintain their nonprofit status with the Internal Revenue Service (IRS). However, the IRS allows hospitals to set their own rules regarding who qualifies for charity care; some hospitals are more generous than others.

There are a lot of payment assistance programs out there. Programs like CHIP and Medicaid are specifically there to help low-income patients lower the cost of healthcare. Check with benefits.gov for programs in your area.

Try to Negotiate

Reach out to the medical facility’s billing department to estimate what you’ll owe. Then, contact your insurance provider to see what they’ll cover.

You can negotiate with your hospital or health care office’s billing department—to ask for a lower balance due on that high medical bill. And getting that discount is easier than you think.

Here are some tips to help you negotiate:

  • Try negotiating before treatment
  • Shop around to find cheaper providers before your service
  • Understand what your insurance covers ─ and what it doesn’t
  • Request an itemized bill and check for errors
  • Seek payment assistance programs
  • Offer to pay upfront for a discount

Watch this video for extra tips on negotiating medical bills.

Ask About a Payment Plan

Payment plans for medical services are often interest-free and more affordable than paying all at once.

The Consumer Financial Protection Bureau (CFPB) recommends getting the plan in writing. Make sure your healthcare provider includes the following details:

  • No interest will accrue.
  • Your medical will not send over debt to a collection agency if you make payments on time.
  • You won’t be required to make the whole payment if you are late or miss a payment.

Hire a Patient Advocate

A patient advocate helps patients communicate with their healthcare providers to get the information they need to decide on their health care. Patient advocates may also help patients set up appointments for doctor visits and medical tests and get financial, legal, and social support.

You can find a patient advocate at:

  • AdvoConnection
  • National Association of Healthcare Advocacy (NAHAC)
  • Patient Advocate Foundation (PAF)
  • Hospitals
  • Senior living facilities
  • Health plans
  • Your employer may offer patient advocacy services as part of their benefits package.

Consider Bankruptcy

Bankruptcy should never be your first option, but it can be a viable choice if you’ve exhausted simpler alternatives. According to one study, two-thirds of all bankruptcies in the United States are related to medical expenses. Filing bankruptcy isn’t free, though. It will cost a minimum of $500 and could go as high as $3500. Talk to a bankruptcy attorney to discuss your options. 

The number of Americans with medical debt is far higher than the number of uninsured people.

Rules on Medical Debt are Changing

The rules for unpaid medical debt are changing: As of July, the three major credit bureaus (Experian, Equifax and TransUnion) will not list unpaid medical bills on your credit reports until they’re a year late. When this happens, it will ding your credit score.

At the same time that new guidelines take effect, all medical debt that was in collections but then paid will be wiped off credit reports. 

The Consumer Financial Protection Bureau (CFPB) reported that Americans have $88 billion in debt and will wipe away 70% of negative medical debt through these changes.

Here are some of the significant changes effective July 1, 2022, if you don’t pay medical bills:

  • Starting the first half of 2023, all three major credit bureaus will no longer include medical debt in collections under $500.
  • Credit reports will no longer include paid medical debt paid in full in credit reports.
  • You will have up to one year before the medical debt is reflected on your credit report, up from six months.

You Aren’t Alone: Medical Debt is Common 

From 2018 to 2019, Americans’ health care spending grew by over 4%. The average adult owed $11,582 in medical bills in that same year. The cost of health care continues to rise, and health insurance companies continue to require higher out-of-pocket costs. 

  • Low-income households
  • Individuals without health care coverage
  • People with less education
  • Uninsured young adults
  • Older adults with Medicare but no other public or private health insurance

However, even those with a higher income or health care coverage aren’t immune to medical debt. There are a few reasons for this, including:

  • Unexpected diagnosis of a significant health problem (ex. cancer) and costly treatment
  • High deductibles and out-of-network costs
  • Paying medical bills off with high-interest credit cards
  • Vague terms in what the health plan covers

In a Healthcare.com survey, 52% of millennials indicated that medical bills harmed their credit scores.

Average Medical Care Costs

Here are the average costs of standard treatments, procedures, and more for uninsured or underinsured. Bear in mind that these estimates do not include prescription drug costs.

To Visit a Doctor’s Office

Visiting your doctor’s office will depend on your health insurance policy and many other factors, including whether you have a high deductible plan, whether the doctor or hospital is considered an in-network provider or if they are considered out of network. Because of these factors, it’s best to be proactive and choose a primary care physician, then set up a physical, so you already have an established history before any emergency strikes. Assuming you don’t have a high-deductible plan, with private health insurance, it will cost:

  • A copay will cost between $20 to $25 to visit a primary care doctor if you have private health insurance
  •  and $50 to $60 to see a specialist.

If you’re uninsured, it can cost anywhere from $70 to $250, which can arise if you need prescriptions or specialty testing.

Telemedicine

Telemedicine has gained popularity as an alternative health insurance option since the start of the COVID-19 pandemic. It’s a way for people to get the medical attention they need without going in person. Due to the nature of telemedicine, it may also be cheaper than in-person visits. Of course, it does have its limitations – for instance, any physical treatments will require an in-person visit.

A 2017 study found that a telehealth visit costs an average of $79, compared to $146 for a doctor’s visit and $1,734 for an emergency room visit.

To Visit an Urgent Care Facility

Urgent care will be cheaper than the ER and should be utilized unless you have a true emergency. The average urgent care bill is around $200, and studies show that about 65% of ER visits could be handled at an urgent care facility.

Urgent care facilities are ideal for:

  • Accidents and falls
  • Cuts that might need stitches
  • Breathing difficulties, such as mild to moderate asthma
  • Diagnostic services, including X-rays and lab tests
  • Eye irritation
  • Fever or flu
  • Minor broken bones and fractures
  • Severe sore throat or cough
  • Skin rashes and infections
  • Sprains and strains
  • Urinary tract infections
  • Vomiting, diarrhea, or dehydration

For an ER Visit

The emergency room (ER) is almost always more expensive than a trip to the hospital. A level 1 triage is considered the most urgent and, therefore, the most costly. A level 5 triage is the least critical and will usually cost less. For context, most people go to the ER for a level 3, which costs around $2,200.

In addition to cost, ERs will often have longer wait times. Whenever possible, try to utilize an urgent care facility instead. Here are some examples of when you truly need to head to the ER:

  • Signs of stroke or heart attack
  • Gunshot wounds
  • Fever in a newborn
  • Poisoning
  • Electrical shock
  • Complications from pregnancy
  • Severe abdominal pain
  • Extreme allergic reactions
  • Burns
  • Open fractures
  • Unconsciousness

For an Inpatient Hospital Stay

What is considered an inpatient hospital stay? As an inpatient, you are under the care of doctors, nurses, and other types of health care professionals within a hospital. Inpatient care is care provided in a hospital or other inpatient facility, where you are admitted and spend at least one night —sometimes more — depending on your condition.

The typical cost of an overnight stay at a hospital is just over $13,000 before insurance coverage. Surgeries and other medical procedures or treatments will push the bill higher.

COVID-19 Hospitalization

Average costs tend to range based on age. Patients ages 23 to 30 are charged $34,662; those between 51 and 60 years old are charged $45,683.

Typical Surgery Costs

Surgery can be more expensive than a new car. Estimates are available from healthcarebluebook.com.

  • Heart bypass surgery: Averages about $75,345
  • Gallbladder surgery: Between $10,000 and $20,000
  • Knee replacement: Around $30,249 (inpatient costs) or $19,002 (outpatient costs)
  • Hip replacement: Starting at $23,000 and going up to $74,000+

The Bottom Line

Don’t ignore a medical bill, but do be sure to take advantage of the more flexible repayment timeframes to negotiate your bills and payments. Keep in mind that damage may take a while to show up on your credit report, but it can have a long-lasting effect and remain on your credit for seven years after being delinquent.

FAQs

Will I Face Wage Garnishment if I Don’t Pay My Medical Bills?

Getting sued over your outstanding medical debt is the worst-case scenario. Your medical care provider may take you to court due to your unpaid bills. If your provider does decide to take matters to court, a potential outcome is that the court could rule that your medical debt must be paid off through wage garnishment.

What is a High-Deductible Health Insurance Plan?

A high-deductible health insurance plan has a higher deductible than a traditional insurance plan. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share of your deductible.

What’s the Difference Between an In-Network and Out-of-Network Provider?

When a doctor, hospital, or other provider accepts your health insurance plan, they’re in-network or participating providers. Out-of-network provider means that a doctor or physician does not have a contract with your health insurance plan provider. Out-of-network providers can sometimes result in higher prices. Some health plans, such as an HMO plan, will not cover care from out-of-network providers, except in an emergency.