Check the bill. You might be protected from billing, which means your medical provider is not allowed to charge you.

• If your insurance company already paid your medial provider, you might be protected from billing.
• If you have MassHealth, the provider (doctor or hospital) can only be paid by MassHealth. The medical provider cannot bill you instead or bill you for additional money, even if they think the care should cost more.
• If you have private insurance, you are also sometimes protected from billing. Some insurance plans protect their members from “balance billing.”

“Balance billing” is when providers get an insurance payment and then bill patients for the “balance” of what they think is owed. If you think insurance (private insurance, MassHealth, 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.

If your insurance is not paying for a service, you can appeal the insurance decision.

Also see “I am not sure how much I owe and who I owe. How can I find out?”

You have the right to appeal if your insurance company, Medicaid (MassHealth), or Medicare will not pay for a service that you need. Your insurer must tell you why they deny the claim in writing within time limits. Here are the insurer’s time limits:

• 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.

To appeal:

1. Call your insurer and tell them you want to appeal their decision. You have to do this by a deadline. It is often 180 days from the date you got the denial, but not always. Do not miss the deadline. 
2. Ask the insurance company why it does not want to pay. 
3. If insurance does not think you need the care, ask your doctor to write a letter of “Medical Necessity.” The letter should say why the test or procedure is medically necessary for you.
   1. You can also find information about the procedure and how it is helpful. You can ask your doctor if they have any articles from medical journals.
4. Ask your insurance company for an appeal form or write out your appeal. See the Patient Advocate Foundation’s list of what to include in your appeal letter.
5. If you can, send copies of:
   1. your doctor’s letter of “Medical Necessity”,
   2. the Explanation of Benefits (EOB) showing your claim was denied, and
   3. printouts, reports, or information about the procedure or test.
6. Make a copy of everything.
7. Mail your letter and documents. Request a return-receipt 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.
 

If you were told that the provider accepted your insurance:

You can call the Attorney General’s Office - Health Care Division (888-830-6277) to report the situation. You might be protected from billing.

If you went to a hospital covered by your insurance:

If you got other bills from the visit (like a laboratory bill or a physician’s bill) that say your insurance won’t cover their services, you can call the Attorney General’s Office - Health Care Division (888-830-6277) to report it. You might be protected from billing.

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 haven’t 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.

• Health Safety Net,
• ConnectorCare,
• MassHealth (Medicaid),
• Medicare Savings Programs,
• Insurance from a current or former employer or spouse,
• Workers’ Compensation,
• Pharmacy assistance programs, 
• Church or social service assistance programs, or
• Low-cost dental care from dental schools.
   

Most hospitals are required to offer financial assistance. Ask for the application and submit it with all the information it asks for. You should get a response back about any discounts you qualify for. If the discount does not seem right, ask for the financial assistance policy.

The organization Dollar For can help with the financial assistance from most hospitals. 

Medical providers can lower your bill if you ask. They agree to accept a lower payment from insurance companies. 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.

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

• 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, Avoid Medical Debt.

Ask for a payment plan. 

If you have a low income, you may qualify for the Health Safety Net. 

If an Acute Hospital or Community Health Center treats you for something medically necessary, they must offer you a payment plan. In some cases, you might also be protected from medical billing.

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.

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.

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

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.
• 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). Here’s a template for a verification letter.
• Last, check your credit report. 

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. But sometimes medical providers send you a bill by mistake before billing insurance. If you have stopped receiving bills and collections notices, and there is nothing on your credit report, you may not owe it anymore. 

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

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

Try to get a lawyer.

Defend yourself against the medical bill collector. Learn more about defending yourself in a debt collection case in small claims court. In a medical debt 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 providers did something very wrong when treating you,
• you were impaired or “lacked capacity” when you signed the contract, or
• you felt like you had to sign the contract.

Important:

If you do not show up to defend yourself, you will usually automatically lose. If you do show up, the judge might understand your situation and you might win.

Also, if you lose a lawsuit for medical debt collection, there will be a judgment against you. This is what allows the medical bill collector to get your money. Several types of income are “judgment proof” like SSI and pensions. Here’s a list of judgment-proof income. If this is your only income and you don’t have any savings, you can tell the provider. The provider may stop the lawsuit because it won’t work to get payment from you anyway.

If the hospital or doctor’s office hired a company to collect the bill, you can probably stop them from contacting you. See What are my rights when debt collectors contact me?

If none of the above options work for you, you may be able to get rid of the bill if you file for bankruptcy. This is called “discharging” the debt. See Answers to common bankruptcy questions.