High Medical Bills with Insurance: A Guide to Understanding and Controlling Expenses

High medical bills with insurance can be a significant financial burden for many people. According to a study, nearly 1 in 5 people with health insurance reported difficulty paying medical bills.

Medical billing errors are a common issue, with 80% of patients experiencing some kind of error on their bill. These errors can range from simple math mistakes to more serious issues like incorrect diagnoses.

In some cases, medical billing errors can even lead to collections agencies being contacted, which can further damage credit scores.

Up to 80% of medical bills contain errors, so it's essential to investigate before paying.

Be wary of collection notices, as debt collectors must provide instructions on how to dispute the debt, and if they don't, it may be a red flag for a scammer.

Older adults with multiple insurance carriers, such as Medicare and private insurance, are at a higher risk of billing errors and inaccurate bills.

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To verify bill accuracy, get an itemized bill from your health-care provider or insurance company, and review it carefully.

If you don't recognize a charge or service, contact the biller to request an itemized list of services and providers of your care.

You can also log into an online account to review a digital bill if you no longer receive paper statements.

The Health Insurance Portability and Accountability Act (HIPAA) guarantees you the right to receive an itemized bill, so remind your provider of this if they seem hesitant.

Scrutinize the billing codes on your itemized bill, which are used to describe health-care services and procedures, and ensure they align with the services you received.

You can look up what the billing codes mean online, and contact your provider directly if you don't think you owe the debt.

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Verify Claim Submission is a crucial step to ensure you're not stuck with a surprise medical bill. Verify a claim was submitted to confirm that your medical provider or facility has indeed sent a claim to your insurance company.

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If you've recently changed jobs or insurers, double-check that the claim was submitted under your current health insurance plan. This will help prevent any confusion or delays in the billing process.

In-network providers have negotiated discounted rates with your insurance company, so you'll typically pay less by going to providers in your network than to an out-of-network provider. This can save you a significant amount of money on medical expenses.

Medical bills can be riddled with errors, with one study estimating up to 80% of bills contain mistakes. Older adults may be particularly vulnerable due to multiple insurance carriers.

Be wary of collection notices, which by law must include instructions on how to dispute the debt. If a notice lacks this information, it's a red flag that you may be dealing with a scammer.

Verify that a claim was submitted under your current health insurance plan, especially if you've recently changed jobs or insurers. This can save you from paying out-of-network prices.

Check your explanation of benefits document to ensure it matches your itemized bill. If there are discrepancies, contact your healthcare provider to resolve the issue.

Scrutinize the billing codes on your itemized bill, which describe the health services and procedures provided. You can look up what the codes stand for online to ensure accuracy.

Ask for an itemized bill that includes billing codes for all care received. This can help you identify errors and negotiate lower charges.

If you're struggling to pay a medical bill, don't be afraid to ask for help. Many hospitals and clinics have financial assistance programs in place to support patients with limited income and assets.

Some hospitals, including those in Minnesota, are required to work with patients to set up a reasonable payment plan if they express an inability to pay a bill all at once. Non-profit hospitals also offer financial assistance programs, which may have names like "charity care" or "community care."

You may be surprised to learn that some hospital systems provide help for people with income levels as high as six figures. To access these programs, you'll need to ask the hospital or clinic directly and be prepared to provide supporting documentation.

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If you're struggling to pay a hospital bill, don't be afraid to ask about a payment plan. Many hospitals will work with you to set up a plan that fits your budget.

You have the right to request a payment plan, and it's a good idea to talk to a nonprofit credit counselor if you're unsure about your options. They can help you understand your choices and create a plan that works for you.

Minnesota non-profit hospitals offer financial assistance programs to help people with limited income and assets pay their hospital bills. These programs vary from hospital to hospital.

You may qualify for Medicaid, subsidized insurance, or charity care programs, depending on your income and the hospital's policies. Don't assume you won't qualify, and be persistent in asking about these programs.

If you're denied financial assistance, ask for a discount on your bill instead. Many hospitals don't do a great job letting patients know about available help, so it's up to you to ask and advocate for yourself.

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Charging bills to credit can be a tempting solution, but it's essential to understand the pitfalls. Credit cards have notoriously high interest rates that can quickly cause medical debt to grow.

If you charge a $5,500 medical bill to your credit card with an 18% interest rate, paying only the minimum monthly payment of $100 will take nearly 10 years to pay off. You'll also end up paying more than $6,000 in interest, increasing the total amount owed to over $11,500.

The more medical bills you place on your card, the more interest you'll owe. It's easy to see how a few procedures can quickly reduce a family's finances to zero.

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Managing Medical Bills can be overwhelming, but there are steps you can take to navigate the process. You're guaranteed to get an itemized bill from your health-care provider or insurance company under federal law, so don't hesitate to request one.

If you receive a bill you don't recognize, contact the biller to request an itemized list of services and providers of your care. You can also log into an online account to review a digital bill if you no longer get paper statements.

Discrepancies between your itemized bill and the explanation of benefits document from your insurer can be frustrating, but don't worry, you can cross-check the two documents to identify any errors. Contact your health-care provider if you find discrepancies.

If you owe a bill, don't be afraid to negotiate for a lower amount. Your health-care provider may be willing to accept a lower lump-sum payment to wipe out the debt.

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Up to 80% of medical bills contain errors, so it's crucial to verify bill accuracy before paying.

Medical billing is notoriously byzantine, and errors can be difficult to spot. However, scrutinizing billing codes on your itemized bill can help identify potential issues.

Your itemized bill will list current procedural terminology, or CPT, codes for medical services or treatments provided. These codes are used to describe health-care services and procedures, so ensure the services you received align with the CPT code on the bill.

You can look up what the code stands for online, and if you don't think you owe the debt, contact the provider directly. Providers hire debt collectors to do this work for them, but that doesn't mean providers won't talk to a former patient if there's a problem.

Comparing the bill with insurance companies' estimates of fair charges for services can also help identify discrepancies. If the price you were charged is more than average, you can have your costs lowered.

Older adults may be at a higher risk of billing errors due to multiple insurance carriers. However, by law, debt collectors have to give people a letter or email with instructions on how to dispute the debt, so be wary of collection notices that don't provide this information.

To ensure the medical provider or facility submitted a claim under your current health insurance plan, check that they are considered "in-network" for your plan. This can help you avoid paying more for out-of-network services.

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If you're struggling to pay a medical bill, don't be afraid to ask for a payment plan. You can work directly with the medical biller or provider to set up an interest-free payment plan.

Some hospitals, like those in Minnesota, are required to work with patients to come up with a reasonable payment plan if they express an inability to pay the entire bill at once. This is due to an agreement between the Minnesota Attorney General and most Minnesota hospitals.

You can also ask if you qualify for financial assistance programs, which vary from hospital to hospital and may have names like "charity care" or "community care." These programs are designed to help people with limited income and assets pay their hospital bills.

Make sure to agree to monthly payments that you can truly afford to make regularly. It's also a good idea to talk to a nonprofit credit counselor to understand your options if you're lost or want a clear understanding of the choices.

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Receiving a Serious Diagnosis can be overwhelming, and the financial burden can be crushing. Medical bills can add up quickly, especially with high deductibles like the $8,300 annual deductible allowed for a high-deductible health plan in 2025.

You'll have to pay that deductible out of pocket before your insurance kicks in, and that can be a significant financial strain. This is especially true if you have ongoing treatment that spans multiple calendar years.

The cost of treatment can be staggering, as seen in the case of a retired couple who had to pay $1,000 each month for their husband's cancer treatment. Over two years, they accumulated $30,000 in debt.

If you're facing a serious diagnosis, it's essential to understand your insurance coverage and what's covered and what's not. Traditional and FDA-approved treatments are generally covered, but some may come with annual limits.

You may also need to pay for experimental treatments out of pocket, which can be a significant financial burden.

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Health care bills can sometimes create unwelcome surprises because it's hard for people to "comparison shop" for health care. Each clinic and hospital sets its own prices.

If you question the cost of a particular service, the best step is to contact the clinic or hospital for an explanation. In Minnesota, hospitals may not charge uninsured patients more than they charge the private insurance company that delivers the most revenue to the hospital, as long as the patient's household income is $125,000 or less.

Here are some reasons why health care pricing can be opaque:

You can simply Google the hospital along with the phrase "charity care" or "financial assistance policy" to determine if you qualify for charity care.

Laws governing hospital charity care require that nonprofit hospitals lower or write off bills for individuals, depending on household income. This is a federal requirement for hospitals to keep their tax-exempt status.

Even if you've already been paying off medical debt, the hospital will be required to refund the payments you've made if you qualify for charity care.

You can also use a simplified online tool, like the one provided by Dollar For, to see if you qualify for charity care.

Related reading: Charity Care for Medical Bills

Observation status can affect the amount you pay if you're on Medicare. This concept is crucial to understand, as it can impact your hospital bill significantly.

The amount you pay can vary greatly depending on whether you're considered an inpatient or outpatient. For example, if you're on Medicare, being classified as an outpatient can result in higher out-of-pocket costs.

To avoid surprise medical bills, it's essential to know your hospital status. You can ask your hospital to clarify your status, especially if you're unsure.

Here are some key points to keep in mind:

By understanding your hospital status, you can better navigate the healthcare system and avoid unexpected medical bills.

Opaque pricing in healthcare can be frustrating and confusing. You might have a good health insurance plan, but still end up in medical debt because providers can't or won't give you prices before you agree to potentially expensive procedures.

Suppose you badly slice your finger in a kitchen accident and visit the emergency room for stitches. You might not know how much the bill will be until you get it in the mail at least a month later. Good luck asking someone at the front desk to give you a cost estimate when you check in, because they don't know what procedures you'll need until a doctor or nurse sees you.

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The hospital where you'll be having a procedure can't seem to tell you upfront how much it will cost. This is because providers and insurance carriers have nondisclosure agreements so neither party can reveal the provider's billed rates nor the insurance company's discounts.

Consumers can't get a straight answer about costs because the provider needs to know who the insurance company is and how the specific plan is designed regarding deductibles and coinsurance. And patients are usually dealing with multiple providers for a procedure, such as a hospital or surgical facility, the surgeon, the anesthetist, and others.

To learn the cost of a procedure upfront, try asking for the billing manager or surgery coordinator. These positions have different titles at different practices, so it can take some work to get connected with the right person.

Here are some steps to help you navigate opaque pricing:

Paying Hidden Costs can be a real challenge, and it's not just about the medical bills themselves. Your out-of-pocket maximum for out-of-network care might be double your in-network one.

You might think you're getting in-network care, but an out-of-network assistant surgeon or lab can still send you a bill. Ruth Linden, a medical-billing advocate, recently helped an out-of-work client in Texas cut a large, unpaid physical therapy bill in half and set up a manageable payment plan.

Many policies limit the number of physical therapy visits per calendar year, but the doctor may recommend more than that number. Any visits beyond the policy's limit will come out of your pocket.

Hidden costs can add up quickly, especially if you need frequent treatments for a health condition. Your transportation costs will increase, and so will your childcare costs. If your illness interferes with work, your income may decrease.

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A good health policy for one person might be terrible for another, depending on their unique needs and circumstances. This is because what makes a policy good is highly individualized.

You might have a chronic health condition that requires a policy with a low deductible, broad network, and 90/10 coinsurance, even if it means higher monthly premiums. This type of policy can provide the necessary coverage for ongoing care.

A semiprofessional cyclist, on the other hand, might be able to get away with a policy that has low monthly premiums and catastrophic coverage in case of a serious diagnosis.

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