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A Survival Guide to Surprise Medical Bills

How to spot errors, fight out-of-network charges and lessen the stress of health care debt

En español | What is Americans’ biggest financial concern about their health care? It isn’t insurance expenses or drug costs. It’s the specter of an unexpected bill. A February 2020 Kaiser Family Foundation poll found that 65 percent of people worry that they won’t be able to afford a surprise medical bill — more than fear being unable to pay for prescription drugs, health insurance premiums or deductibles, or for staples such as food, rent, mortgage and gas.

That probably comes as little surprise to anyone who’s opened an envelope from a hospital or doctor’s office and found a three-, four- or five-figure bill for care they thought their health plan would cover. One in three insured adults aged 18 to 64 report receiving an unexpected medical bill in the past two years, according to the Kaiser Family Foundation survey, and in 11 percent of those cases the cost exceeded $1,000.

While some states have laws in place to shield consumers from surprise medical bills, there is no nationwide protection. That may soon change. Bipartisan groups in both the House and Senate, and the White House, have gotten behind efforts to restrict the chief cause of surprise bills: "balance billing," which occurs when patients are treated at medical facilities in their health plan's network but are seen, and charged, by out-of-network doctors.

In the meantime, though, many patients still face the stress of getting a big medical bill they didn't see coming. We asked billing experts, consumer advocates, health care analysts and financial professionals for insight on surprise bills and what you can do about them. These articles aim to help you break down your bill, work with providers and insurers to reduce your costs, and pay down medical debt without jeopardizing your financial health.