Where to start when you need help paying medical bills

First, take a breath

A big medical bill can feel scary. Many people feel ashamed, but you did nothing wrong. Health care is expensive, and bills are often confusing. Some bills are wrong, and many are open to change. You usually have more time and more choices than the first letter makes it seem.

This guide is a short plan you can follow one step at a time. You do not have to finish it in one day. If you want help with the actual phone calls, our guide on how to negotiate a medical bill has scripts you can read out loud.

Step 1. Gather your papers and check the deadlines

Put every bill and letter about this care in one folder. Write down the date on each bill, the amount, who sent it and when it is due. If you were insured at the time, keep any explanation of benefits too. That is the paper from your insurer that shows what it paid and what it says you owe.

Look for any letter that mentions a collection agency, which is a company hired to collect unpaid bills. If you find one, do not ignore it. The Consumer Financial Protection Bureau says a first step is to find out about the debt and decide whether you really owe it. It also says a collector must tell you the name of the creditor, the amount owed and how to dispute the debt.

Step 2. Ask for an itemized bill

An itemized bill lists each charge on its own line, so ask for one before you pay anything and check it for charges that do not match your visit. Our guide on how to negotiate a medical bill has a phone script for this call. You can also ask the billing office to hold the account while you review it.

Step 3. Ask for financial assistance

Financial assistance, sometimes called charity care, is free or reduced-price care for people with limited income. The IRS requires nonprofit hospitals to have a written financial assistance policy and to share it widely.

Call the billing office and ask for the policy and the application. Many people never apply because they do not know it exists, and you may qualify even if you have a job or some savings. Our guide on hospital financial assistance walks through how to apply and what proof you may need.

Step 4. Ask about discounts and payment plans

If you do not qualify for assistance, or you still owe something afterward, ask about a self-pay discount. Also ask about a payment plan, which lets you pay in smaller pieces over time. Our guide on how to negotiate a medical bill has the scripts and the questions to ask about interest and fees.

If you were quoted a price before your care and the bill came in much higher, see our guide on the good faith estimate.

Step 5. Look for nonprofit and community help

Besides the hospital, other groups sometimes help. Hospitals often have a social worker or patient advocate who knows about programs. Local charities and church groups may help with bills or related costs such as medicines. In many areas you can call 2-1-1, a free helpline that points you to local services. Ask each group what proof they need and how long it takes.

If the bill came from a visit that was not an emergency, you may avoid more surprises next time by choosing a lower-cost doctor. Community health centers charge by income, and we explain how in what is a community health center. Our directory can also help you find cash-pay doctors who post their prices.

Be careful with medical credit cards and loans

Sometimes a provider or a company offers a special card or loan to pay a medical bill. These can look easy, but they can cost much more than the original bill. Some offer a no-interest period, but you may owe interest on the full amount if you do not pay everything off in time. Others have high interest rates from the start.

• Ask what the interest rate is after any free period ends.
• Ask whether interest is charged back to the first day if you miss the deadline.
• Ask what fees or penalties apply to the account.
• Compare the offer with a plain payment plan directly with the hospital, which is often cheaper.

A payment plan with the provider usually costs less than borrowing from a new lender. Take your time before you open a new account.

What if I get sick again before this is solved?

Do not skip care because of an old bill. If you think you are having an emergency, call 911 or go to the nearest emergency room right away. Emergencies include chest pain, trouble breathing and signs of a stroke.

Federal law requires an emergency room to examine and stabilize you whether or not you can pay. For everyday care, our guide to care with no insurance lists lower-cost options. This page is general education, not medical or legal advice.