The Truth About Medical Bills - And How to Push Back

Traci Arieli
Aug 14
4 min read

An estimated 41% of adults in the U.S., over 100 million people, are burdened with some form of healthcare debt. That’s not a fringe issue. That’s nearly half the adult population feeling the weight of bills they often didn’t expect, don’t fully understand, or shouldn’t owe at all.

If you’ve ever opened a medical bill and felt a mix of confusion, disbelief, and anxiety - you’re not alone. And the good news? You’re not powerless, either. Whether it’s a confusing insurance denial, an unexpected charge, or a bill that feels too high, there are ways to question it, reduce it, and sometimes even eliminate it.

Let’s break it down step by step so the next time a bill shows up, you’re ready.

Step 1: Know What You’re Owed - And What You’re Not

One of the most powerful tools you have is knowledge, especially when it comes to what your insurance should cover and what providers are allowed to charge. The truth is, a lot of what ends up on medical bills isn’t your responsibility. But if you don’t know that, you might end up paying anyway.

Start with preventive care. Under the Affordable Care Act, many routine services, like annual checkups, mammograms, and vaccinations, are required to be covered at no cost to you. If you’re charged for those, it could be a billing error or a misclassification (sometimes referred to as “coding”) issue.

Always ask these three questions before a scheduled service:

Does my insurance cover this?
Do I need a referral or pre-authorization for this service?
Are all the providers I’ll see (e.g., anesthesiologist, radiologist) in-network?

Also, don’t hesitate to call your insurance company and ask for a Summary of Benefits. It breaks down what’s covered, what isn’t, and what your financial responsibility should be. When something feels off, it probably is. A little research upfront can save you a big headache later.

Step 2: Decode the Medical Bill Before You Pay

Many people confuse the Explanation of Benefits (EOB) with an actual bill. The EOB is a summary from your insurer that shows what was billed, what they covered, and what you may owe. Your actual bill is sent separately by the provider or hospital.

Here’s what to look out for:

Duplicate charges (the same procedure listed twice)
Upcoding (a more expensive service listed than what you received)
Out-of-network surprises for in-network procedures (e.g., labs or specialists snuck into a hospital stay)

If something doesn’t make sense, call the billing department and ask them to walk you through each line item. You’re not being difficult; you’re doing your due diligence.

And whatever you do, don’t pay immediately to get it over with. You have the right to ask questions, request itemized bills, and even negotiate.

Step 3: Speak Up and Push Back With Confidence

You don’t need to be an expert to advocate for yourself; you need to ask the right questions and stay calm, even when the system feels overwhelming.

If a bill doesn’t look right or a claim is denied, start by calling your insurance provider and saying:

“Can you help me understand this charge?”

“Was this denied because of missing paperwork or a coding issue?”

“What steps can I take to appeal this decision?”

When talking to a hospital or provider’s billing office, you can say:

“I’m reviewing my bill, and I’d like an itemized copy.”

“This amount seems higher than expected. Can you explain what it includes?”

“Are there any discounts or payment plans available?”

Keep notes of every conversation, including names, dates, and reference numbers. If you’re using a patient portal, take screenshots of chats or upload correspondence. Documentation gives you power if you need to escalate.

And remember: You don’t have to do this alone. Nonprofit patient advocates, hospital ombudsmen, or even state insurance departments can help you navigate the appeals process or negotiate a reduced bill.

Step 4: Explore Discounts, Appeals, & Financial Aid

Before you pay anything, ask: “Is there a discount if I pay in full?” Many providers offer prompt-pay discounts, but they rarely advertise them. You have to ask.

If you’re facing a denied claim, know this: you have the right to appeal. Insurance companies often reverse decisions when patients push back, especially if there was a documentation error or missing pre-authorization.

Also, don’t overlook financial assistance programs, even if you have insurance. Nonprofit hospitals are required to offer them, and many people qualify without realizing it. Some request income documentation, while others require only a brief form.

Useful places to check:

The provider’s website (look for “Financial Assistance” or “Charity Care”)
Patient advocate foundations
Your state’s department of insurance

You might be surprised how much help is available if you know where to look and aren’t afraid to ask.

You’re Not Being Difficult—You’re Being Smart

Medical bills can feel overwhelming, especially when you’re already dealing with stress, illness, or caregiving. Remember that you’re allowed to ask questions, push back, and protect your financial well-being. You should.

You don’t have to know everything. You just have to know that you deserve clear answers, fair treatment, and support when you need it most. So the next time a confusing bill lands in your mailbox or inbox, take a breath and take action.

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