What can you do with an emergency room bill that's bigger than your annual income?

Can't Afford the Emergency Room Bill

TDS Reader Solutions

Can't Afford Emergency Room Bill

Eight months ago, I had to visit the ER. I stayed there for 24 hours. They did two EKGs, x-rayed my chest, did lab tests, and gave me one shot and one tablet. Now I got a bill for $18,000. My total household income is $2800/month. My mortgage, car insurance, gas, and utilities are almost close to that amount. I don't have any insurance. What are my options? I cannot pay that bill.

Contact the Hospital

Contact the hospital for an appointment with the billing department, taking along your last two year's tax returns and evidence of your monthly expenses. Many hospitals will either greatly reduce the fees or eliminate them all together once they can review your true circumstances.

If there are still fees to be paid, then structure a payment plan directly with the hospital and stick to it; this will help to avoid collections from appearing and damaging your credit rating. Keep all receipts in the event you have to prove your payments to a credit reporting agency.

Do Not Ignore Bill

Please contact the hospital and let them know that this bill is a hardship and that you have no insurance coverage. Most hospitals have a department that deals with clients who cannot pay and that department can usually adjust the billing to a more reasonable level.

Do not ignore this bill. Be proactive, and you will most likely be able to have the bill reduced, sometimes by as much as half. If you ignore the bills and they have to send you to collections, it is much harder to have the bill reduced. Send a letter to whomever you speak to confirm what was said on the phone. If the person you speak to is not sure how to help you get a bill reduced, ask to speak to a supervisor. Keep careful notes and be polite. Send them a payment of whatever you can afford. They would rather get a small amount each month and keep you out of collections.

From Someone Who Knows…

Most hospitals will work with you on the emergency room bill if you tell them you don't have insurance and/or have low income. There are also programs that vary by state for uninsured/underinsured patients, particularly for the unemployed. Go to the billing department at the hospital and tell them where you stand. They will be able to give you some help. How do I know this? I work for a hospital and we see this all the time.

Make a Deal with Cash

I'm a nurse, so I've heard variations of this story often. The day you got your first bill you should have:

  1. Called the hospital and talked to them immediately. Never wait. You should have asked to speak to a social worker to help you and work with you to perhaps qualify you for Medicaid and/or any special programs.
  2. Also the billing department knows perfectly well that an $18,000 bill would be paid to the tune of $1000 to $1500 (if that) by most third party carriers, so you can often make a deal if you pay cash. Offer $500, but remember you have bills for the ER physicians, etc. Call everyone involved and ask politely and respectfully. Keep track of every person you talk to, what they say, and when.
  3. Normally, if you pay $10 a month, they can do nothing. However, who wants this hanging over their head? It is often better to try to make an arrangement. It's may also be beneficial for taxes.
  4. Try getting help with the Help Column in your local newspaper and/or television station, even a local reporter. Remember that they like to hear interesting stories and often can help you and give advice, as can your local politicians. Hospitals are businesses, and they don't want news people or too many people looking too closely at them and their billing practices.
  5. AHCA and JCAHO accredit hospitals and like to hear about abuses of the system. These are names that are handy to mention when talking to hospital administrators.


Prove Your Income

I, too, once had a huge medical bill that I could not pay and collectors were constantly calling about it. I inquired about social services at my hospital. They have a program that will help pay your bill according to your income. I filled out a small application, brought copies of my tax returns, mortgage bill, electric bill, etc. Within a few weeks, the lady called me to say that my bill had been paid in full. What a relief!

Am I a good candidate for bankruptcy?

Always Put a "Face" to a Request

Many hospitals have a "patient advocate" or ombudsman. A personal visit to that individual might be a good place to start. These folks know the ins and outs of hospital finance and they have a good handle on community resources. They know what adjustments the hospital can or cannot make. Whatever you do, don't ignore the bill, and if possible, avoid using the phone for your first contact with any one person. If you can actually visit the person you're asking for help, it puts a face to the problem, and it's human nature to respond stronger to someone you "know" than a voice on the phone.

If a physician's bill is part of this problem, try asking the doctor to forgive the bill or to let you pay the Medicare rate (which would be a small fraction of the bill). A handwritten note to the doctor at his office may really help (don't type and don't use the billing address because the doctor may not see your note). My late husband, who was an MD, was always willing to do this for anyone who asked if he felt there was a good reason and the asker was sincere.

Related: 6 Ways to Get Help Paying Your Medical Bills

Stand Your Ground

I was bitten by a poisonous spider and taken by ambulance to the local emergency room where they did various tests, applied an anti-venom, and sent me home with Tylenol at $2.50 per tablet! The total bill was over $8,000, which, in our local rural community, equals nearly six months of wages. I, too, had no insurance.

After receiving the emergency room bill, I contacted the hospital. I made it clear that not only could I not pay it, but that I thought the billing was outrageous and was willing to risk their anger. They asked for me to provide some documentation on my liquid assets, and once they found I had very little cash available, my bill was reduced to $591, which I was allowed to pay off at slightly over $13 per month.

I later learned that one of the reasons hospitals charge so much for services rendered under insurance or accidents is to make-up for the discounts they otherwise provide in a situation such as yours. Don't be afraid to ask and stand your ground.

Minimize Credit Damage

Look into State Health Insurance

Our family makes near this amount too and we qualify for state health insurance. You could look into that and it would pay for bills you incurred in the past three months. If you do not qualify, every hospital has its own funding and assistance program that would greatly reduce that bill, and you could setup monthly payments of an amount that you can afford.

Ask for an Itemized Bill

Get an itemized emergency room bill. They have to provide one if you ask. Go through it. Many mistakes are made there.

You'll Get Through This

My son was in the same spot. He worked out an arrangement with the hospital where he worked weekends as a volunteer. Volunteer hours equaled money off his bill. He also got a reduced bill after the hospital examined his wage statements and tax return. He still owed a lot of money, but at least it was about half of the original bill. He is still making monthly payments of about $150 a month. He also asked that any future gifts (birthdays, etc.) be cash payments for his bill. He seriously considered bankruptcy and was told, in consultation with a lawyer, that the number one reason people file for bankruptcy is medical bills! He sold one of his vehicles instead and the family now gets along with one car. An $18k medical bill may seem insurmountable, but remember that it's like any other debt, such as a car loan or education loan.

Reviewed October 2017

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