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Medical Debt

Produced by Massachusetts Law Reform Institute
Created December 2019

I cannot afford my medical bills. What can I do?

Check the bill. If your medical provider is billing you because your insurance is not paying for a service, appeal.

If you think insurance, Medicaid, or Medicare should have paid a bill, contact your insurer. Ask why they did not pay for the service. If the insurance company should have paid, they may be able to fix it when you call. Sometimes the provider does not use the right "code" when they bill the insurance company. You may need to talk to your provider to have them correct the bill code.

Appeal

You have the right to appeal if your insurance company, Medicaid, or Medicare will not pay for a service that you need. Your insurer must tell you why they deny the claim in writing:

  • If you are asking for prior authorization for a treatment, within 15 days,
  • For medical services you already received, within 30 days
  • When you need urgent care, within 72 hours.

Call your insurer and tell the insurer that you want to appeal their decision. They have a deadline. It is often 180 days from the date you got the denial, but not always. Do not miss the deadline. To appeal:

  • Ask your doctor to write a letter of “Medical Necessity.” The letter should say why the test or procedure is medically necessary for you.
  • Find information about the procedure and how it is helpful. You can ask your doctor if they have any articles from medical journals.
  • Ask your insurance company for an appeal form or write out your appeal. Use our automated system to help write your appeal letter here.
  • Include copies with your letter of:
    • your doctor’s letter of “Medical Necessity”,
    • the Explanation of Benefits showing your claim was denied and
    • printouts, reports or information about the procedure or test.
  • Make a copy of everything.
  • Mail your letter and documents return-receipt requested or, if you fax it keep a copy of the fax receipt.

The date you send the letter is very important because there is a deadline to appeal.

If you need help filing your appeal, the Attorney General’s Local Consumer Program may be able to help.

Having problems appealing?

Call the Massachusetts Division of Insurance if:

  • the Insurance company says they will not look at your appeal, or
  • if your appeal is for a service you have not gotten and you did not hear back in 30 days, or
  • if your appeal is for a service you already had and they have not told you the result within 60 days.

If your health insurance company denies your appeal, ask for an “external review.” Your insurance company must tell you how to ask for an external review if they deny your internal appeal.

Learn more about appeals at Healthcare.gov.

Get a second insurer or another program to pay the bill

Apply for insurance and assistance programs. If you have insurance with another insurance plan, they may cover the part of the bill your first insurance did not pay. The second plan is sometimes called “co-insurance.” Think about applying for:

  • Health Safety Net,
  • Connector Care,
  • Medicaid,
  • Medicare Savings Programs,
  • Insurance from a current or former employer or spouse,
  • Workers’ Compensation,
  • Pharmacy assistance programs. You can find these programs using the Medicine Assistance Tool,
  • Church or social service assistance programs, or
  • Low-cost dental care from dental schools.

Find a way to pay for it

Ask for a payment plan.

If you have low-income you may qualify for the Health Safety Net. If an Acute Hospital1

or Community Health Center treats you for something medically necessary, they must offer you a payment plan:

For bills under $1,000

You must make a deposit. But then providers must offer you, a payment plan that gives you at least a year to pay the bill. They cannot charge interest and they cannot ask you to pay more than $25 a month. 2

For bills over $1,000

Providers must offer patients who have bills of more than $1,000 a plan that allows them at least 2 years interest-free to pay the bill. 3

Providers who are not acute hospitals or community health centers may also let you pay over time and not charge you interest.

Negotiate to lower the bill

Medical providers can lower your bill if you ask. They agree to accept a lower payment from insurance companies. 4 Ask them to lower your payment too.If the medical provider agrees to lower your bill get the agreement in writing.If the bill has gone to a debt collector, ask the provider to tell the debt collector to remove or correct any negative information they reported to the credit bureau.

What not to do

It is usually a bad idea to get a 2nd mortgage or use your credit card to pay your medical bills:

  • Credit cards charge a high interest rate.
  • If you miss a payment on a credit card you pay a late fee. Medical bills rarely have late fees.
  • Credit card companies are harder to negotiate with than medical bill collectors.
  • If you ever decide to file for bankruptcy, you can probably get rid of medical debt. If it is part of your mortgage, it is harder to get rid of it.
  • If you use your mortgage to pay your medical bills and you cannot pay your mortgage you could lose your home in foreclosure.

The Consumer Financial Protection Bureau has a toolkit to help Avoid Medical Debt.

I know I have medical bills, but I am not sure how much I owe and who I owe. How can I find out? 

If you had to go to the hospital you may owe money to more than just the hospital. Doctors, the ambulance, labs and companies that run tests may each bill you separately.

To find out who you owe money, and what you owe them for:

  • Ask the hospital for a full list of itemized charges.5
  • If you have insurance, ask for an Explanation of Benefits (EOB.) The EOB shows you the amount you owe for co-payments, deductibles and money your insurance company refused to pay.
  • If someone is asking you for money, ask the debt collector for a “verification of the bill.” See the Fair Debt Collection Practices Act (FDCPA).

Note

You need to do more than look at your credit report. It is not complete. It does not list the name of your medical providers or the services they provided. 6

I owe money to a doctor or hospital. Can they refuse to treat me?

In an emergency a hospital should always treat you even if you have debt.7

In a non-emergency they can ask you to pay a deposit before they treat you.  Or they can say ‘no’ until you pay your bill.

If you get Medicaid, you should be able to get services even if you owe co-payments or deductibles.

A medical debt company is suing me what can I do?

Try to get a lawyer.

Defend yourself against the medical bill collector.  Learn more about defending yourself in a debt collection case in the consumer section. A court case with a medical bill collector is not the same as one against a credit card debt collector.  In a medical collection case you could have defenses and claims like if:

  • Your provider told you the wrong information about your insurance coverage,
  • you do not read English and the provider only gave you the contract in English,
  • your provider’s did something very wrong when treating you,
  • you were impaired or “lacked capacity” when you signed the contract,
  • you felt like you had to sign the contract.

A medical debt company is harassing me, what can I do?

If the hospital or doctors’ office hired a company to collect the bill, you can probably stop them from contacting you.  See What To Do About Debt Collectors in the Consumer section.

You can sue the company if they are breaking the law.  Try to get a lawyer.

Or you can probably get rid of the bill if you file for bankruptcy.  This is discharging the debt. See the Bankruptcy section.

Find Legal Aid

You may be able to get free legal help from your local legal aid program. Or email a question about your own legal problem to a lawyer.

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