Medical Bills You Can't Pay

Step 1: Make sure the bill is right

1. Ask for an itemized bill that lists every charge with its billing code. A summary bill that only says "balance due" isn't enough to check.
2. Compare it with your insurer's Explanation of Benefits (EOB). Look for duplicate charges, services you didn't receive, and charges the insurer says you don't owe.
3. If your insurer denied a claim, appeal. Most health plans must offer an internal appeal, and if that fails, an independent external review. Your denial letter explains how and lists the deadlines.
4. Don't pay while a bill is being reviewed or appealed. Ask the provider to put the account on hold while you sort it out, and note who you spoke with.

Step 2: Ask about financial assistance (charity care)

Most hospitals in the US are nonprofits, and federal tax rules require nonprofit hospitals to have a written financial assistance policy, publish it, and offer free or discounted care to eligible patients. Depending on the hospital, eligibility can reach well into middle incomes, not just the very lowest.

• A nonprofit hospital generally can't take "extraordinary collection actions" against you, like suing, reporting to credit bureaus or selling the debt, until at least 120 days after its first bill following your discharge.
• You can apply for assistance for at least 240 days after that first bill, and if you qualify after you've already paid, you may be owed a refund.
• Some states go further. California, for example, requires hospitals to offer free or discounted care to many lower- and middle-income patients.

How to ask: call the hospital's billing office and say, "I'd like to apply for financial assistance. Can you send me the application and your financial assistance policy?" The policy is usually on the hospital's website too.

Step 3: Use the surprise-billing protections

The federal No Surprises Act protects most people from surprise out-of-network bills for emergency care, and for certain care from out-of-network providers at in-network hospitals and surgery centers. In those cases you generally owe only your in-network cost share.

If you're uninsured or paying yourself, you have the right to a Good Faith Estimate before scheduled care. If the final bill is at least $400 more than the estimate, you can dispute it, generally within 120 days of getting the bill.

Questions or a bill you think breaks these rules: call the No Surprises Help Desk at 1-800-985-3059 or visit cms.gov/nosurprises.

Step 4: Negotiate what's left

• Ask for a discount for paying in full, or ask what the self-pay rate is. Providers often accept less than the billed amount.
• Ask for an interest-free payment plan directly with the provider. Many will set one up at an amount you can actually afford.
• Be careful with medical credit cards and medical loans. Many offer "no interest" periods with deferred interest: miss the payoff date and you can be charged all the interest back to day one. A plan directly with the provider is usually safer.
• Get any agreement in writing before you pay.

Medical debt and your credit report in 2026

Under policies the three national credit bureaus adopted in 2022 and 2023:

• Medical collections aren't reported until they're at least one year past due.
• Paid medical collections are removed from credit reports.
• Medical collections under $500 aren't reported at all.

A federal CFPB rule that would have kept nearly all medical debt off credit reports was struck down by a federal court in July 2025, so it isn't in effect. Some states, including California, have their own laws limiting medical debt on credit reports. If you see a medical debt on your report that shouldn't be there, dispute it with the bureau. You can check your reports free at AnnualCreditReport.com.

When medical debt is part of a bigger problem

If medical bills are stacked on top of credit cards and other debts, compare the bigger options. Nonprofit credit counseling and settlement both commonly include medical debt. Compare all six options or try the budget builder to see what you can realistically put toward debt each month.

Sources

• IRS, Billing and collections, Section 501(r)(6), and financial assistance policy, Section 501(r)(4)
• CMS, No Surprises Act: ending surprise medical bills
• National Consumer Law Center, The latest on keeping medical debt out of credit reports (updated September 2026)
• CFPB, Debt collection consumer tools

General information, not legal or medical billing advice.