A Timeline for a Hospital Bill You Can't Pay

What to do each week, from requesting an itemized bill to answering a collection call, so a hospital bill you cannot pay does not become a debt you cannot control.

This guide is general information for borrowers in the U.S., not financial or legal advice. Lending laws differ by state and change over time; check with your state's financial regulator or a nonprofit credit counselor about your situation.

Key points

1. Under the Affordable Care Act, nonprofit hospitals must have a written financial assistance policy and give you a free copy when you ask.
2. Review an itemized bill for duplicate charges and confirm your insurance was applied before paying anything.
3. While a financial assistance application is pending, you can ask debt collectors to hold off on collection activity.
4. An unpaid hospital bill can bring added fees, collection activity, a lawsuit, garnished wages and a lower credit score.
5. Before paying a collector, ask both the collector and the hospital to verify the amount, then check it against your itemized bill.

A hospital bill you cannot pay feels like a deadline with no instructions. The sequence you follow, though, matters more than raw speed: assistance programs, billing disputes and payment arrangements all take time to work, and each one gets harder to use once a bill is past due. The timeline below runs from the day the bill arrives to the first collection call, with a concrete task for each week.

Week 1: Get the Itemized Bill and Check It for Errors

Start by confirming you actually owe the money; sometimes a bill has already been paid, or a provider or collector has confused you with someone of a similar name. Then check the charges. Ask the billing office for an itemized list and look for errors such as being billed twice for the same service or billed for care you did not receive. The billing office’s number is on the statement.

If you have health insurance, check that it was applied correctly by comparing the bill with the explanation of benefits from your plan. If you disagree with what the insurer paid, you can file an appeal within your insurance company and, failing that, ask for a review by someone outside it.

Two federal protections may also apply:

• The No Surprises Act, effective January 1, 2022, protects people with insurance from many surprise out-of-network charges, including charges for emergency services, and gives uninsured patients some protections as well.
• If you were not using insurance and got a good faith estimate before scheduled care, you can dispute a bill that is at least $400 above that estimate. An independent reviewer decides whether you were charged too much and can reduce the bill.

Move quickly here; resolving charges early helps you avoid added fees and interest.

Week 2: Ask About the Hospital’s Financial Assistance Policy

Under the Affordable Care Act, nonprofit hospitals must have a written financial assistance policy, sometimes called charity care, and a written emergency medical care policy. The hospital must give you a copy of the policy free of charge, and it must explain how to apply. Hospitals must also offer a plain-language summary at intake or discharge, list program contacts on billing statements and post the policy in public spaces.

If nothing appeared in your paperwork, ask anyway; hospitals do not always follow up, so the details are easy to miss. Searching the hospital’s name plus “financial assistance” online, or calling the billing department, usually turns up the policy.

Before applying, read the policy and answer three questions:

• What are the eligibility requirements?
• What is the deadline for applying?
• Is the assistance free care, discounted care, or both?

Nonprofit hospitals must offer this help in exchange for the tax benefits they receive, and for-profit hospitals may have assistance policies too, so ask either way. Some states go further: all Washington State hospitals, for example, must tell patients about financial assistance verbally and in writing and screen them for eligibility before trying to collect payment.

Week 3: Apply for Charity Care or Medicaid Coverage

Fill out the hospital’s application form. Be ready to show your income with documents such as a prior-year tax return or a recent pay stub, and to list expenses like housing payments, utilities, credit cards and other debts. The hospital may let you submit the form online or by mail.

While your application is pending, ask the billing office how long a decision usually takes, whom to contact if you get stuck on the form, and what the hospital will do with the balance meanwhile. Then check the status yourself rather than waiting silently.

State programs add their own rules, so check what applies where you live. In New Jersey, the Hospital Care Payment Assistance Program serves patients at acute care hospitals with no coverage or coverage that pays only part of the bill, and applicants must be screened for Medicaid first. In Washington State, income rules for charity care changed substantially in 2022, and patients can apply regardless of immigration status.

Applying costs nothing, so it is worth doing even if you are unsure you qualify. If you suspect a nonprofit hospital is not following the financial assistance requirements tied to its tax status, you can notify the IRS.

Week 4: Set Up a Payment Plan You Can Afford

If financial assistance is denied or covers only part of the bill, talk to the billing department about the rest. Providers can sometimes lower the price, and they may offer payment plans. Propose an amount you can sustain each month, because a modest plan you keep beats a larger one you miss.

You do not have to work through this alone. Patient advocates can handle medical billing issues on your behalf, and some states have Consumer Assistance Programs that advise patients in the state where they got care. A trusted friend or family member can also speak with the hospital for you if you are sick or overwhelmed.

One caution: a payment plan works best when nothing else competes for the money. Before borrowing for medical bills, look at help that already exists. Our guide to help to look for before you borrow covers bill, food and rent programs that can free up cash for the plan you just set up.

Month 2 and Beyond: What Happens if the Bill Goes Unpaid

If you do nothing and do not pay, the consequences compound: added penalties and interest, collection activity, and possibly a lawsuit, wage garnishment and credit damage.

Medical debt is common and often accidental. The Consumer Financial Protection Bureau’s 2022 report on medical debt burden counted $88 billion in outstanding medical bills in collections, affecting one in five Americans, and found medical debt to be the most common collection on consumer credit records. Two-thirds of medical debts come from a one-time or short-term expense tied to an acute medical need.

Once bills enter collections, they are often reported to the credit bureaus, which can affect your ability to rent or buy a home, the price of a car loan or insurance, and even a job search. Staying engaged with the hospital, or keeping a pending assistance application alive, beats letting the bill drift.

When Collections Contact You: What to Say and Ask

A collection call does not end your options. Before paying anything, confirm the amount is accurate: you can ask the collector, and the hospital, to verify what they say you owe. Third-party collectors often have limited access to provider records, which makes it hard to confirm that the balance they claim is valid.

Then take these steps:

• Tell the collector you are seeking financial assistance for the bill and ask them to hold off on collection activity while the hospital reviews your application.
• If the collector has already reported the debt on your credit, ask that it be shown as disputed.
• You can also challenge a medical bill with the collector itself or with the credit bureaus that list it.

If a collector misuses the process, you can submit a complaint with the Consumer Financial Protection Bureau online or by calling (855) 411-CFPB (2372).

Be careful

Do not pay a collector before confirming the claim. Ask the collector and the hospital to verify the amount, then check it against your itemized bill.

Related guides

• Help to Look for Before You Borrow: Bills, Food, Rent and Medical Costs covers assistance programs that can reduce the pressure to borrow while a hospital bill is pending.
• Debt Collectors, Fake Collectors and Loan Scams explains how to tell a legitimate collector from a scammer before you send anyone money.
• Before You Fall Behind on Utility Bills: A Checklist applies the same early-action approach to keeping lights and heat on while you manage medical debt.

Common questions

Can I get hospital financial assistance if I have insurance?

Yes. Charity care and hospital financial assistance programs may help patients who are uninsured and patients who are insured but underinsured. In Washington State, for example, charity care applies to out-of-pocket costs like copays and deductibles regardless of insurance status.

What documents do I need to apply for charity care?

Hospitals typically ask for proof of income, such as a prior-year tax return or a recent pay stub, plus expenses like housing costs, utilities and credit card payments. Requirements vary, so read the hospital's own policy before applying.

What happens if I just ignore a hospital bill I can't pay?

Doing nothing is the riskiest option. The bill can pick up added fees and interest, move into collections and end in a lawsuit, garnished wages and a lower credit score, while you lose the chance to use financial assistance or a payment plan.

Can a hospital bill reach collections while my assistance application is pending?

If the bill is already with a collector, tell them you are seeking financial assistance and ask them to hold off while the hospital reviews your application. Ask the hospital's billing office what happens to the bill while your application is processed.