A trip to the emergency room led to the most expensive holiday side dish I’ve ever made. ’Twas the night before Christmas and all through the house … just kidding, it’s not that kind of story. I dropped a butcher knife on my big toe while making a casserole. I left my husband home with the kids, drove to the closest urgent care clinic and got a couple of stitches. The next day, the casserole was wonderful, but the medical bill I received a few weeks later? Not so much. 

Turns out I had gone to an out-of-network ER clinic, and our insurance didn’t lift a penny to help. My very minor emergency cost upwards of $1,000. Even when I called to protest the line item for “medical supplies”—I mean, really, how much does a needle and thread cost?—I couldn’t talk them down. Lesson learned. Now I always double-check that I will be meeting with in-network providers. 

But sometimes, you have no control. An ambulance might just need to take you to the nearest hospital—in or out of network. There might be a specialist you need to see—no matter the cost. Insurance might cover a routine checkup—but not the bloodwork and additional tests you end up getting. 

So when a gasp-inducing bill arrives, don’t stress and don’t give up fighting as quickly as I did. There are steps you can take to manage medical bills and, perhaps, even reduce them.

First and foremost, always question the bill. According to Caitlin Donovan, senior director of the nonprofit organization Patient Advocacy Foundation (PAF), when a medical bill arrives, you should expect there to be a mistake. “Don’t panic,” she says. “Be proactive.” 

“Human error is the biggest driver of mistakes on a medical bill,” says Donovan, who tracked her own bills during one of her pregnancies and found errors in exactly half of them. So even if a bill doesn’t strike you as off in any way, it can pay (literally) to verify each charge. For example, sometimes a big bill means the provider billed you directly by mistake, instead of billing the insurer first, according to Donovan. “Wait for your Explanation of Benefits (a statement from your insurance company explaining what amount they will cover) to come in the mail before you pay,” she says. “Compare that number to the bill.” If the figures don’t match, start making calls and asking questions. 

Know what your insurance covers. Familiarize yourself with your plan benefits so you can identify suspicious bills. Donovan got a $250 bill for a lactation consultation that she knew should be fully covered. It was a simple coding error she was able to point out. “They didn’t know I do this for a living,” she says, laughing. 

Ask for help. Seek a local medical advocate, a specialist who can help you save between 15% and 30% on medical costs. Some of these pros earn a commission on savings they gain for you, but it may be worth it. You also can turn to a nonprofit like the PAF, which educates patients about billing and has case managers who can advise you. 

Donovan remembers one Tennessee couple who wrote to the PAF about $30,000 in medical bills and how the organization researched the situation and had the bills reduced to $0. The PAF also looks at other aspects of patients’ finances, such as housing or budgeting, to help them manage their medical debt load. “Your health and your finances are intimately intertwined,” she says, so it’s important to seek help to avoid getting stuck in a vicious cycle.

Ask if you qualify for financial assistance. Hospitals and providers have different criteria for granting financial aid, so it doesn’t hurt to ask what they are and to fill out any necessary paperwork. Donovan says that even if your insurance company has paid what it’s supposed to, refrain from paying the remaining amount (if it’s quite large) until you have at least asked if you qualify for aid.

Negotiate a payment plan. “Every hospital is different, and every patient’s situation is different,” Donovan says. Some people have a high-deductible health plan with a Health Savings Account (HSA) or an employee plan with a co-pay. Others are insured through the Health Insurance Marketplace under the Affordable Care Act. Once you know exactly what you owe, be honest about your financial situation. “Tell the accounts payable representative what you can afford to pay now and what you can pay monthly.” And make sure to examine your finances and your budget first so you can make a realistic commitment. “Don’t tell them you can pay $500 a month of the bill if you can’t,” Donovan warns. The last thing you want is for the bill to go to a collection agency.

Do your research. Look up what the average cost is for the service you received to see if your bill amount is in line with the going rate. Then, you’ll be in a better position to negotiate costs and payment plans.

Understand the economics that influence your bill. Hospitals negotiate a rate with insurers, and it differs among plans. Though providers are required to post their negotiated rates, not all of them do. So ask ahead of time to avoid surprises.

Take advantage of the No Surprises Act. This new legislation, effective in 2022, protects consumers and patients by:

• Requiring hospitals to keep an accurate directory on in-network insurers.
• Allowing patients 90 days to find a new in-network provider. “You still get insurance coverage while you’re looking,” Donovan says.
• Protecting patients from exorbitant ER costs for necessary treatment. 
• Reining in billing for ancillary services, such as anesthesiology or radiology. 

“The legislation is really trying to cover instances when patients didn’t have a choice or weren’t informed,” Donovan says.

Jennifer Chappell Smith has more than 25 years’ experience writing about lifestyle, personal finance and more. She and her husband live in San Antonio, Texas, where they’re raising three boys.

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