What to do when you get a health care bill:
Do not ignore the bill.
It will not go away.
- Check the bill to be sure you really got all the services listed on the bill.
- If you do not understand the bill, call the phone number on the bill.
- Write down the date that you call. Write down the names and phone numbers of everyone you talk to and what each person tells you.
- Ask questions until you understand.
- If the bill is not correct, write to the place that sent the bill. Tell them why it is wrong. Include a copy of the bill. Be sure to keep the original bill and a copy of your letter.
I Have Insurance. Why Am I Getting a Bill?
Your health insurance may not pay for some services. Or it may pay for only part of the cost. You may have to pay part yourself. Here are some tips:
- Check the explanation of benefits (“EOB”). Make sure the doctor’s bill has the same amounts as the EOB.
- Make sure the doctor or collection agency has your correct insurance information. If not, call and give it to them. If your insurance changes, call right away with the new information.
- Make sure your doctor accepts your insurance.
- If you have Medicaid, Medicare or certain public insurance, the doctor cannot bill you for a covered service. Even if the doctor did not send the bill to Medicaid on time, the doctor cannot bill you.
- If you get services that are not covered benefits, you must pay for those services. For example, Medicare does not cover cosmetic services.
What Should I Do if I Think the Bill is Wrong?
Call your insurance company if you think the bill is wrong. The customer service number is on your membership card.
- Ask if the service you received is covered. If it is, ask why they did not pay the bill.
- Ask how they can fix the problem.
- If they cannot fix the problem right away, you can tell them you want to file an appeal. An appeal is also called a grievance. An appeal lets you explain why the bill is wrong and why it should be changed.
- Ask how to file your appeal. Ask what the deadline is, and be sure to meet that deadline.
- If you can, file your appeal in writing and keep a copy.
- Ask your doctor to write a letter to the insurance company saying why you needed the care you got. Ask the doctor to send you a copy of the letter.
- You may want to get a lawyer to help you with your appeal. See “Where can I get more help?” at the end of this screen.
Do I Have Any Other Choices?
- Ask about a financial assistance program:
Before you make a payment, ask the doctor or hospital’s financial office if they have a financial assistance program. Financial assistance programs offer free or almost free care. If you apply for financial assistance and you do not get a response within two weeks, call back and ask what has happened. If they say their financial assistance funds are gone for the year, ask when you can apply again.
- Negotiate the amount of the bill:
You might be able to get the doctor or hospital to lower the amount you owe, or not bill you at all, if you explain why you cannot pay the bill.
- Make a payment plan:
If you cannot pay the bill all at once, ask the doctor or hospital for a flexible payment plan. This lets you pay part of the bill each month until it is paid off. However, you may have to pay interest also. Call the number on the bill to set up a payment plan. When you call, have your account number handy. This number is printed on the bill.
What If A Collection Agency Calls?
A collection agency is a company that your doctor or hospital hires to collect the money they think you owe. You can still apply for financial assistance, or you can work out a payment plan with the doctor or hospital. See “Do I have any other choices?”
If a collection agency contacts you:
- Ask for a written explanation of everything on the bill.
- Keep a copy of all bills you get and all letters you send.
- Each time someone calls you about the bill, write down when they called and what they say.
- If the bill is wrong, send a letter to the collection agency within 30 days after you get the first bill from them. Tell them that the bill is wrong and why.
- If you have Medicaid, tell them they cannot bill you for a covered service, and they must bill Medicaid instead.
- If the bill is correct and you cannot pay the full amount, ask if you can pay a lower amount or pay over time.
- Make sure they have your correct insurance information and have billed Medicaid or your insurance company. Call Medicaid or your insurance company and ask why they did not pay the bill.
Federal laws prohibit a collection agency from harassing you.
- A collection agency cannot call you at work. They cannot call you before 8:00 in the morning or after 9:00 at night. If you have a lawyer, the collection agency should only talk to your lawyer.
- They cannot tell anyone else about your debt.
- They cannot call repeatedly.
- They cannot threaten you, your property, or your reputation. They cannot use obscene, profane, or abusive language.
- If you think the collection agency is harassing you, you may want to get a lawyer. See “Where can I get more help?” below. You can also file a complaint with the Federal Trade Commission. Call 877-382-4357. Or visit www.ftccomplaintassistant.gov .
Where Can I Get More Help?
For free and low-cost health clinics:
- Visit Northern Virginia Health Services Coalition at www.novaclinics.org.
For legal help:
- Call the Legal Services of Northern Virginia at 703-778-6800.
- If you do not qualify for legal aid help, call the Virginia Lawyer Referral Service at 800-552-7977. The lawyers they refer you to may charge a fee. Tell them that you have a low income or ask for a reduced fee.
For help if you or a family member has HIV or AIDS:
- Call Whitman-Walker Health Legal Services at202-939-7627.
For help with Medicare and other programs for seniors:
- Call the Virginia Insurance Counseling and Assistance Program (VICAP) at 800-552-3402.
For help if you have a disability:
- Call the Virginia Office for Protection & Advocacy at 800-552-3962.
If you have a chronic, debilitating, or life-threatening disease:
- Call the Patient Advocate Foundation’s Virginia Cares Uninsured Program at 800-532-5274.