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Theres a silver lining to this shit cloud.

How to Pay Hospital Bills When You’re Flat Broke

It’s a fucking travesty that the leading cause of bankruptcy in these United States is medical bills. Not credit card bills nor risky investments. Not even student loans, but hospital bills. Invoices racked up through freak accidents and diseases the patient certainly didn’t ask for and would probably prefer to live without.

To our readers in other, more civilized countries, you’re dismissed. This week we’re going to be dissecting a uniquely American problem: exorbitant medical bills and how to pay them.

The CEO of GoFundMe, an online crowd-funding platform, never dreamed that his company would become synonymous with “I’m broke and need $300,000 to pay for my child’s cancer treatment.” What he envisioned as a way for entrepreneurs and artists to raise money for their passion projects has become the last desperate hope of sick and injured Americans on the verge of total financial ruin.

It blows, dear readers. It fucking blows.

Which is why we need to get creative with some of the lesser-known and best ways to pay for medical bills. Sure, it might be cheaper in the long run to move to Canada, Sweden, or Namibia. But if you bleed American blood on American soil, here’s what you do.

Audit the bill

Great news! More than half of all hospital bills contain errors. Isn’t that cool? It means you’ve probably been grossly overcharged for medical care at some point in your life!

All kidding aside, there’s a silver lining to this shit cloud. It means that when you get a large hospital bill, you can have it audited to check for the kinds of mistakes that could artificially inflate what you owe. And there are a few kinds of errors that are pretty common in medical bills.

Up coding

Hospitals and insurance agencies use codes to identify particular medical procedures. I’m assuming these codes make use of both gallows humor and clever wordplay to get the actual meaning across.

Sometimes the code used on your bill doesn’t match the procedure actually performed. This is known as up coding. So you could have gone in for a pretty routine procedure, but the code for a more serious, complex procedure will appear on your bill. Imagine seeing your doctor for a basic cholesterol test and getting a bill for open-heart surgery. That’ll add a few extra zeroes to your bill pretty quick.

The good news is an auditor can compare the patient records and doctor’s notes against the codes in the hospital bill to make sure they match up. If they find a discrepancy in the codes, they can correct it, potentially saving you money.

Level of service charge errors

Hospitals have “levels of service” that roughly equate to how crucial the care you received was. For example, a sprained ankle constitutes a low level of service since it’s a relatively mild injury that will require little specialized care to heal. A broken leg is a higher level of service, in that you should definitely get it fixed by a doctor but it’s not going to kill you. And a collapsed lung is a high level of service in that it constitutes a lifesaving procedure.

An error in the level of service charge means that you went in for a minor tune-up and they charged you for a new car. They billed your sprained ankle as if it were a collapsed lung. So you definitely want an auditor to catch that sort of thing.


There are standard fees for procedures in different cities and regions. Just as the cost of living is different between Monocle Metropolis, California and East Bumfuck, Georgia, so is the cost of medical care.

A medical billing specialist keeps track of these standard fees in various locations. So they can tell if you were charged as if you life in San Francisco when you actually live in Duluth.

I’m assuming this means you can save a little money on the front end by seeking medical care in cheaper areas. But this isn’t always an option, especially for emergency care or when you need frequent treatment.


Remember that a generic is always, always cheaper than the name brand product. Hospital billing departments understand this all too well, as they’ll sometimes upsell patients to a name brand drug when a doctor prescribed the generic version.

An audit can catch these bait-and-switches. And you’ll be glad they did.

Duplicate charges and nonexistent procedures

Sometimes the hospital just… inexplicably charges you multiple times for the same shit! Or a doctor will recommend a procedure, the patient will refuse it, but the procedure will stay on the bill. This isn’t the only kind of clerical error that can appear on your bill, but it’s certainly easy for an auditor to spot.

Because believe you me, the bloodsucking fiends in the hospital’s accounting department certainly aren’t going to bother.

How to audit a medical bill

Getting an independent audit of your medical bill is easier than… well, easier than paying your entire bill without help. Simply contact a medical bill auditing service like Medical Billing Advocates of America.

Just make sure your auditor is a Certified Professional Medical Auditor (CPMA) and that they’re an external organization, not a department of the hospital where you received treatment. Those fuckers are the ones trying to bleed you dry, metaphorically speaking. And if you tell the hospital you’re requesting an audit, they may try to talk you out of it, claiming that an audit could have you paying more in the end. Ignore them.

Get a discount

Hospitals would rather you pay something than not pay anything at all. So just like any other bill, you’re much better off trying to cut a deal than ignoring the bill if you can’t pay it all.

Whether or not you choose to audit your extravagant medical bill, one of the first steps you should take is to call the hospital’s billing department to see if you can work something out.

In researching this article, I ran across several stories of people getting their bills reduced by hundreds of dollars. The catch? They just had to pay that very same day. This is what’s known as the “prompt pay discount,” and you should definitely ask for it.

Hospitals will also set you up on an interest-free payment plan if necessary. Certainly better than putting your hospital bill on a credit card, especially if you can negotiate the hospital down to a monthly payment that will fit comfortably within your regular budget.

Some hospitals will even offer you an uninsured discount, which seems a little backwards given that they probably would prefer you have insurance. But hey, any port in a storm, baby!

And just like any other contractor, the hospital might give you a discount for paying in cash. Yes! Cold hard cash! Also a flex spending account which is basically cash! Don’t ask me why! And also don’t ignore your hospital bill when you have these kinds of discounts at your fingertips just for the asking!

Comparison shop

If you’re buying a car, renting an Airbnb, or hiring a contractor, you’re going to comparison shop to find the best deal, right?

So why don’t we do this with hospitals?

Different hospitals charge different rates for the same procedure. Don’t ask me why. Probably because they can.

Obviously it’s hard to comparison shop for healthcare providers when you’re in the throes of a major medical emergency. For the love of Dog, don’t stop to compare prices if you’re bleeding out from a chest wound or going into anaphylactic shock. But if you know you’ve got a medical procedure coming up (non-lifesaving surgery or childbirth, for example) and you have the time to compare prices between hospitals, why the hell wouldn’t you?

In general, for-profit hospitals will cost more than nonprofit hospitals. Likewise, hospitals in high cost-of-living areas will charge more than those in lower cost-of-living areas. Why? Again:

Here’s how you can comparison shop between hospitals:

  • Call the motherfuckers and ask them for individual estimates. Some will list this information on hospital websites for the phone-averse.
  • Check out your state’s Department of Public Health, which sometimes lists median prices by hospital online. Note that these numbers reflect the prices before insurance.
  • Many insurance providers will actually have interactive price-comparison tools on their websites. So if you have insurance, use this resource you’re already paying for.

Financial aid

Here’s some brand new information: hospitals have financial aid departments! And you can ask them to help with your medical bills!

In fact, nonprofit hospitals are legally required to provide charity care to low-income people. That means the financial aid departments at these hospitals literally have the power to reduce or eradicate your bill based on how financially fucked you are.

That said, you’ve got to qualify at a certain level of financial fuckitude. So be prepared to bare your financial soul to the hospital’s financial aid department so they can determine if you’re eligible.

Hospital provided financial aid will only be provided once you’ve exhausted all other avenues for paying your bill. Which leads me to our thrilling conclusion!


Lastly, there’s insurance. Which really, should come firstly in your plan to pay for healthcare. Because while health insurance might seem like an unnecessary expense for every month you don’t use it… the one time you do need to use it you’ll be glad for the money it saves you.

You’ll need to get insurance before something goes horribly wrong with your health. Consider your insurance a “just in case” fund. Just in case everything in your life goes tits-up and you need lifesaving medical care… get insurance while you’re still tits-happily-forward. Because after you’ve been maimed, mangled, or otherwise laid low by all the misfortunes that can befall a human body, nobody will insure you. That’s what we call “pre-existing lack of foresight.”

For more on how insurance works and we Bitches’ personal experience with the world of hospitals and health insurance, check out these finely crafted articles:

Even with insurance, you’re not out of the bankruptcy-by-hospital-bill woods yet. In fact, many people who went bankrupt because of medical bills were actually insured at the time they received their life-decimating hospital bill. The co-pays, deductibles, and uninsured procedures were just too astronomical to afford. Which kinda makes me just want to burn it all down, y’know?

If you’re lucky enough to think, “Paying for medical bills isn’t that hard if you just have insurance and an emergency fund,” then I will not-so-gently remind you that 40% of Americans can’t rustle the couch cushions for $400 in an emergency.

Incidentally, $400 is how much I paid during a trip to the ER a year ago. While a heroic doctor was bandaging burn blisters the size of eggs on my hand and arm, a nice lady from the billing department came into my hospital room to ask how I’d be paying my insurance co-pay. “What’s that? I didn’t hear you over the moaning and the screaming. Will that be credit or debit?”

In a moment like that, no one should have to worry about how they’re going to pay for medical care.

And yet here we are.

7 thoughts to “How to Pay Hospital Bills When You’re Flat Broke”

  1. Thank you so much for writing this. I had no idea about half of this stuff. When I can I’m planning to get all my medical care outside the US, but in the case of an emergency while I’m still living here this is an amazing list of things to look into. Thank you again.

    1. I do not pay for hospital bills. Fuck them. Since I never answer my phone, collectors can call me until they are blue in the face. If the bills get serious, like in 100k, I’d leave this dump.

  2. I had to have my gall bladder out in September of 2017. I drove myself to the hospital and refused the ambulance at the urgent care center which also meant that I couldn’t have any pain medication. That saved me some $$. I refused as much pain medication as I could at the hospital before and after the surgery. When I got my bill, I researched every medication listed on my bill to ensure there were no errors. Nope. I called the hospital to try and get a huge discount to pay it off in full. But the staff told me they only gave large discounts for bills over…$15k. Mine came in just under $10k. Because they were only offering a savings of $200 to pay the bill in full, I had them put me on a payment plan for the longest time period they could which was 24 months. I took the full 24 months to pay it off. Since then, I have been plagued with minor health problems. If you have insurance, please call them prior to having anything other than a routine exam done. The insurance companies will let you know how much out of pocket you need to pay and the most covered options you have.

  3. Ugh, the “up-coding.” I ran into one of those errors on the insurance companies’ end, which was a nightmare to sort out. I had to have an ultrasound in a separate facility as the result of a ruptured ovarian cyst. All this should have been covered by my insurance, minus a copay. However, the insurance company billed it mistakenly under some weird subsection that indicated that the ultrasound was the result of a car accident. Which has its own set of rules involving auto insurance things, that my public transportation using self doesn’t even understand. No matter how much I called, the company refused to change it because “well, it says here it was auto-related.” Even after my OB-GYN submitted documentation that this was due to a cyst, it took them seven months to adjust this. All the while, I was getting repeated bills and calls from the ultrasound facility, threatening collections and adding interest for nonpayment every week. Every few days, I called the insurance company, my doctor, and the facility to check on the progress, repeated the same damn things, faxes document after document, and nothing happened. It was like banging your head against a damn wall, with the same fucking time commitment as a part time job.

  4. A hospital will accept the smallest payment monthly that you can make. If you can only pay twenty dollars per month then tell them and they should accept the payment plan.

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