What to do if…
a medical provider threatens to pause your care unless you pay an unexpected balance

What to do now

1. Switch to emergency care first if needed.
   If symptoms may be serious or are rapidly worsening, call 911 or go to a hospital emergency department. At most hospital emergency departments, federal EMTALA protections mean the hospital must offer an appropriate medical screening exam. If an emergency medical condition is found, the hospital must offer treatment until the condition is stable or an appropriate transfer. Insurance questions must not delay the exam or treatment.

2. Ask for the demand in writing.
   Ask: “What is the exact amount, what dates and services is it for, and what service are you saying will be paused?”
   Request an itemized bill, the account number, and whether the amount is a copay, coinsurance, deductible-related balance, past-due bill, or deposit for future services.

3. Ask the billing office whether a temporary hold is available.
   Ask for Patient Financial Services or the billing office. Say: “I am verifying this balance. Can you place a temporary hold on the account while you send the documentation and I contact my insurer?”
   Ask for written confirmation of any hold that is granted.

4. If you have insurance, call the insurer using the number on your insurance card or portal.
   Ask whether a claim was submitted for the service, what the plan says you owe, whether the provider and facility were in-network, and whether any authorization issue affected the claim. If the claim may need correction, ask whether the provider can correct or resubmit it before collecting the disputed amount.

5. If the charge may be an unexpected out-of-network bill, ask whether federal protections may apply.
   Ask your insurer whether the No Surprises Act may apply to the service and whether the amount should be reviewed before you pay it.

6. If you do not have insurance, or are not using insurance to pay, ask about a Good Faith Estimate for planned or requested services.
   Usually, a provider must give you a Good Faith Estimate if you ask for one or schedule care far enough in advance. Keep a written copy. If a later bill from a provider or facility is at least $400 more than that provider’s or facility’s estimate, ask about the patient-provider dispute resolution process. Good Faith Estimates are not provided during emergency care.

7. Ask about financial assistance and payment-plan options before borrowing money.
   Ask: “Do you have a financial assistance or charity-care policy, and can you send me the policy and application?”
   A tax-exempt hospital organization must establish a written financial assistance policy for each hospital facility it operates. Other providers may also offer discounts or payment plans.

8. Save the details.
   Write down the date, time, name of the person you spoke with, the amount requested, the service that may be paused, and any next step they gave you. Save portal messages, emails, bills, and voicemails.