I Need Help Getting or Paying for Medical Care

If the Person Needs Care Now

Don’t let an insurance, referral, or payment problem become the reason an urgent medical problem goes unaddressed.

For an emergency, call 911 or go to an emergency room. Hospital emergency departments have to evaluate and stabilize people whether or not they can pay.

If you aren’t sure it’s an emergency, see Is This an Emergency? →

Find What’s Stopping the Care

Ask:

“What’s stopping this care from happening, who owns that step, and when should I follow up?”

The problem may be the provider, referral, authorization, insurance, scheduling, or cost. Each one has a different fix and a different person responsible.

Don’t assume that recommending or ordering care means it’s been arranged.

If the Referral or Appointment Is Stuck

Ask:

• Was the referral actually sent?
• Did the provider receive it?
• Did they accept it, or is something missing?
• When can the person be seen?

If they can’t see the person soon enough, ask:

“If this provider can’t see us, who can?”

Ask about another clinician, another location, telehealth, or a cancellation appointment.

For help following a referral through, see I Got a Referral. What Next? →

If Insurance Is Delaying or Denying the Care

Ask the health plan:

• Why is it delayed or denied?
• Is anything missing?
• What review, appeal, or exception is available?
• What deadline applies?

Ask for the reason in writing.

Ask the clinician’s office whether the plan offers a peer-to-peer review or another clinician-to-clinician review, and when it has to happen.

Then ask:

“What happens if this care is delayed, and what should we do safely while this is being resolved?”

Read the denial notice and find the deadline before you put it aside. Don’t let repeated phone calls cause an appeal deadline to pass.

If Medicare denied a claim or says coverage is ending, see Medicare Denied or Is Ending Coverage →

If Cost Is Stopping the Care

Ask what insurance or another benefit will pay and what the person will owe.

Ask for an itemized bill and check it before you pay. Look for charges you don’t recognize or the same service billed twice.

If the care is through a hospital or health system, ask for the financial-assistance office before agreeing to financing or a payment plan.

Nonprofit hospitals are required to have a written financial-assistance policy. Ask for it by name.

Say:

“I want to know whether financial assistance could reduce this cost before I agree to a payment plan. How do I apply?”

If a bill already exists, still ask whether it can be reviewed for financial assistance.

If the bill is from another nonprofit health-care provider, including a nonprofit hospice, ask whether it offers charity care or financial assistance. The hospital rule doesn’t automatically apply to every nonprofit provider.

Ask about an interest-free payment plan before using a credit card or financing offer.

If there’s no usable insurance, ask a community health center, hospital financial counselor, or social worker where the person can get the care and what it’ll cost.

Also ask about coverage. You can apply for Medicaid any time, and losing qualifying health coverage may open a window to enroll in a Marketplace plan. Start with the state Medicaid office or HealthCare.gov.

If the problem is a prescription, see I Need Help Paying for My Medications →

If it’s getting to the appointment, see I Need Help With Transportation to Medical Appointments →

If the Answer Keeps Being No

Go back to whoever is coordinating the medical care.

Say:

“This care still isn’t happening. What’s the next medically workable option?”

Ask whether there’s another provider, treatment, location, funding route, or temporary plan.

One failed route doesn’t make the medical need disappear.

Before You Rely on the Plan

Know:

• what’s blocking the care
• who owns that step
• what has been approved or scheduled
• what the person will have to pay
• what deadline applies
• what happens while you wait