Huge Medical Bills, Tiny Income. What Now?

Dear Debt Adviser, I was recently critically ill and required a lot of medical tests and finally surgery. Now I am stuck with thousands of dollars of medical copays, and my husband and I only have $80 leftover at the end of the month to pay 20 separate medical bills. We do not overspend in any way. He works full time, and I am on Social Security. We try to cover some of these bills monthly with $40 of our spare $80, but it doesn't go very far. What is going to happen to us when we get behind in our payments? What can we do about this situation? -- Helen

Dear Helen, Getting sick is no fun for anyone. Thank heavens that's behind you now, and you are feeling better. I mention this just to remind you that things could always be worse. Although you have medical copay bills that are unpaid, you did have insurance that covered the bulk of the costs. Now that we are looking on the positive side of the situation, let's see what we can do about those bills.

For the bills that were from a hospital rather than a doctor, you should check the Health Resources and Services Administration website at and determine if the facility where you had surgery is covered under the Hill-Burton Act. The Act provides that hospitals, nursing homes and other health facilities that received government money must provide free or reduced-cost services to patients in return for the money received. The program has not been funded since 1997, but some facilities are still under obligation to provide free and reduced-cost services if you fall below the poverty guidelines.

If any of the facilities that you owe are listed as Hill-Burton obligated facilities, you must apply for the free or reduced-cost care. You may still apply after care has been provided and even after a bill has been turned over to a collection agency.

Next, before the medical bills are considered past due, I recommend that you communicate in writing directly with the provider of the service (the doctor, lab, hospital, etc.) and explain your financial situation. Request that your medical copay be waived and your bill considered paid in full. Include a copy of the explanation of benefits to remind the provider that the majority of the cost has been covered by your insurance. Whenever possible, address the letter to the person directly responsible for your care, not the medical practice or a billing agent.

Those service providers who are unwilling to waive your copays will need further communication. In a second letter, state that if the copay cannot be waived, you are requesting to pay out the balance due in monthly installments of what you can afford to pay. Let them know in general how you arrived at the figure you are proposing for a monthly payment.

The larger the number of providers you owe, the more likely it is you won't be able to reach a workable solution. It won't be for lack of trying on your part; rather it may be just a function of the billing and collection process in place in the medical industry today. I mention this so you don't get sick with worry if they turn you down. The law provides for cases just like yours; I am referring to the bankruptcy law. Should you be unable to reach a resolution with your providers, I suggest that you contact an attorney who specializes in bankruptcies to determine what other options you might have available. An attorney can help you determine if a negotiated settlement or a bankruptcy would be in your best interest. Either way, the lawyer can keep the uncooperative providers from suing to collect and help avoid possible wage garnishment or bank levy.

Good luck!

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