Many Americans struggle to pay medical bills. So much so that thousands of people have turned to crowdfunding website GoFundMe to raise money from friends, family and strangers to help pay medical expenses, according to a recent study from Erin Duffy, Assistant Professor at the USC Price School of Public Policy and Scholar at the USC Schaeffer Institute for Public Policy & Government Service.
But there are other ways to get help if you receive an unexpected or unaffordable medical bill. We caught up with Duffy to learn how patients can get help with troublesome medical expenses, from correcting errors on their bills to receiving financial assistance. Her responses were lightly edited for length and clarity.
How many Americans receive unexpected or unaffordable medical bills?
In a nationally representative survey study, we found that 1-in-5 American households had received a bill that they either could not afford or that they did not agree with in the prior year. The most common sources of these bills were physician office visits, emergency or urgent care services, hospital care, and imaging services.
What should patients do when they receive such a bill?
Call the billing office if you have concerns about your bill. In our study, people who reach out to the billing office in response to problematic bills often find some resolution. Three-quarters of those who reached out regarding a bill they could not afford were able to access financial relief, such as financial assistance, payment plans, discounts, and bill cancellation.
Among people who suspected an error on their bill, three-quarters got the bill corrected when they contacted the billing office. When people reached out to negotiate the prices on the bill, roughly 60% achieved a lower price.
What prevents patients from advocating for themselves?
People with higher financial literacy, higher educational attainment, and who scored higher in extroversion and lower in agreeableness on personality tests were more likely to advocate for themselves when they received a problematic bill in our study.
We also asked the people who did not reach out to the billing office for their reasoning, and 85% reported that they did not think calling would make a difference – yet the resolutions among those who did call suggest otherwise.
What if patients can’t afford the bill? What are their options?
Start by calling the billing office to explain that you cannot afford your bill, and inquire about financial assistance, discounts, and payment plans. Eligibility for financial assistance is typically income-based, and additional payment plans or discounts for prompt payment can be available even to those who don’t qualify for financial assistance.
One of our studies identified that the overwhelming majority of hospitals offer payment plans, but patients typically have to call the hospital billing office to learn about these plan options. There may be much more financial flexibility than one would assume when reviewing the bill, but the only way to learn about this is to call.
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Find Out MoreHow can patients “shop” for procedures beforehand?
We conducted a “secret shopper” study to understand what patients experience when seeking information about how much a planned medical procedure will cost, what financial assistance and payment plans are available, and when money would be owed. We found that patients typically have to talk with three different offices at a hospital to get the information they need:
- The financial aid office can let you know how to apply for assistance if you are considered low-income. You can often even get assistance with deductibles, coinsurance, and copayments if you are insured but cannot afford the cost-sharing in your health plan.
- The billing office can provide information on payment plans and discounts.
- The admissions office (sometimes called the scheduling office) can let you know what amount you’ll be expected to pay before the procedure occurs.
Patients may need to ask to be transferred across different offices if they aren’t able to learn all the information they are seeking from the first person they speak with. Many hospitals and other healthcare providers are able to provide cost estimates prior to procedures, and patients can also reach out to their insurer to verify coverage for a planned service.
If you’re able to learn about the out-of-pocket costs and multiple care providers, then you can compare the financial arrangements and choose the best option for you.
What should patients know about navigating bills from an emergency?
There are consumer protections that privately insured patients should be aware of when facing bills for emergency services at facilities and emergency air ambulance transport. When an emergency strikes, you may need to go to a healthcare provider that is outside of your network due to your location, urgency, or other factors outside your control. The No Surprises Act, implemented in 2022, limits the cost-sharing you have to pay in such cases to the amount that you would have paid at an in-network provider. Before this law, patients could receive bills for the difference between the provider’s billed charge and their insurers’ payments – known as “surprise” or “balance” bills. Knowing your rights is important for navigating medical bills.
Unfortunately, these protections don’t exist yet for ground ambulances, and patients may still face very high bills for out-of-network ground ambulance transport.
What can policymakers do to help?
Expanding access to insurance is an important part of reducing the affordability burdens in our healthcare system. Medicaid expansion and subsidized coverage in the individual health insurance marketplace have increased the share of Americans with health insurance, and policymakers can continue bolstering these programs.
There have also been critical improvements in price transparency and consumer protection in recent years, enabling patients to better navigate the healthcare market. One promising step has been passed into law but not yet implemented – Advanced Explanations of Benefits. Once implemented, insured patients will have the right to get an estimate of their cost-sharing, generated collaboratively by their healthcare provider and insurer, before any planned healthcare procedure. Efforts to curb healthcare prices and lower high deductibles could also go a long way toward helping patients afford care. Local governments are also buying and forgiving their residents’ medical debt, but this is far from a cure.
