Your doctor orders blood work or requests you get a biopsy, or maybe your kid broke a bone and you need to rush to the emergency department. A few months later, a bill arrives in the mail with an astounding figure. Despite the federal No Surprises Act made into law in 2022 — which prevents providers from saddling patients with huge bills for out-of-network services — many Americans have felt the shock of a medical bill.

About half of American adults report difficulties affording health care costs, according to KFF polling conducted in 2022, and about 41 percent carry some form of medical debt. A 2021 Census Bureau analysis found that about 14 million people owed more than $1,000 in medical debt, while 3 million Americans owed more than $10,000. KFF surveys also show that excessive medical debt disproportionately affects those who are uninsured, Black and Hispanic adults, and people with lower incomes.

The expense of medical care in the US, paired with a lack of transparency around how much these services will cost and why, can add to the shock and terror that comes with a medical bill; one in four adults said they skipped or delayed medical care in the last 12 months because of the cost, according to the KFF survey. Moreover, a staggeringly high bill at the start of a new year, when health insurance deductibles reset, can add insult to injury. Because new deductibles are often higher than the previous year’s, you might not be prepared to shoulder more out-of-pocket costs.

However, patients have tools and negotiating power to reduce these costs both before services are rendered and after they receive a bill. While many patients may resign themselves to paying the bill, there are a bevy of other cost-cutting options to exhaust first. “You should never ever pay any medical bill right away,” says Caitlin Donovan, the senior director of the Patient Advocate Foundation.

Unfortunately, the responsibility is solely on the patient or their guardian to advocate for themselves; hospitals and medical providers will often not readily offer cost-reducing alternatives. And despite the No Surprises Act’s relatively recent protections for emergency care, many people are unaware they’ve been inappropriately billed, while some providers flout the legislation’s rules. Knowing the right questions to ask can help patients reduce or even avoid huge medical bills.

What to ask while you’re still at the hospital, doctor’s office, or pharmacy

There are questions you can ask providers and pharmacists before you get a test, procedure, or prescription filled to ensure you’re not paying more than you need to. In emergency situations, some of these questions won’t apply since there may not be time to shop around when it comes to lifesaving care. In non-emergency circumstances, the first thing a patient can do to avoid a large bill for something as simple as an office visit is to visit providers that are in-network with your insurance if you have it. Your insurance carrier’s website or app will have a search tool for in-network providers. Also check the list of accepted insurances on the physician’s website. If you’re still unsure if a doctor is in-network, call your insurance carrier and speak with a representative.

“A lot of the time when we see people with really big bills,” says Casey Schwarz, the senior counsel for education and federal policy at the Medicare Rights Center, “it’s because they’re trying to access something that’s either not covered or out of network.”

These bargaining tactics require a significant amount of time and energy, and are made considerably more difficult when you’re not feeling well or English isn’t your first language. Under the Affordable Care Act, patients who speak limited English are entitled to a free qualified interpreter and translated medical documents. Health care providers must inform patients that they offer interpreting services. When booking an appointment, tell the scheduler you will need an interpreter during your visit.

For non-emergency procedures and appointments at in-network physicians, here are some financial questions to ask before you leave the office.

How much will this cost?

Since 2021, federal law has required all hospitals to list pricing information online for services, such as blood work or X-rays, provided during inpatient admission and outpatient........

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