Unexpectedly high medical bills are common in the United States, but there are ways to get relief. According to the Consumer Financial Protection Bureau, 1 in 5 Americans are affected by outstanding medical debt, for a total cost of $88 billion.

In a 2022 study, the bureau found that roughly 20% of U.S. households report that they have medical debt, with collections appearing on 43 million credit reports. As of the second quarter of 2021, 58% of all bills in collections on credit records were medical bills.

Medical debt affects households unevenly, too, according to the agency. Past-due bills are more prevalent among Black and Hispanic people than white and Asian people, and medical debt is more common in the South, in part because states in that region did not expand Medicaid coverage.

While the process of fighting high medical bills can be time-consuming and frustrating, advocates stress that patients shouldn’t be intimidated by the system. If you’ve received a surprise medical bill, here’s what you should know.

See if you qualify for charity care

When Luisa, 33, received a medical bill for over $1,000 after an emergency hospital visit for a viral infection, she was able to have the whole amount covered by the hospital after appealing to their financial assistance policy.

Luisa had heard about the patient advocacy organization Dollar For thanks to a viral video, and she filled out the nonprofit’s online form after receiving her surprise bill. The organization contacted the hospital. Eventually, the hospital contacted Luisa directly to let her know she did in fact qualify for financial assistance.

Laws governing hospital charity care require that nonprofit hospitals lower or write off bills for individuals, depending on household income. To determine if you qualify, you can simply Google the hospital along with the phrase “charity care” or “financial assistance policy.” Dollar For also provides a simplified online tool for patients to see if they qualify.

Appeal to the federal No Surprises Act

While protections against surprise bills have long existed for those who have Medicare, Medicaid and Tricare, laws are now also in place for those with private or marketplace insurance.

The federal No Surprises Act covers people who have insurance through their employers, the marketplace or individual plans. It says that insurance companies must reasonably cover any out-of-network services related to emergency and some non-emergency medical care. That means that if you’re being charged more than you’re used to or expect when you receive in-network services, that bill may be illegal.

To challenge any bill covered under this law, you can use the free help desk and hotline of the Centers for Medicare and Medicaid Services. Many states also have free consumer assistance programs to help with disputes and insurance questions.

Ask for an itemized bill

Medical billing is notoriously byzantine and rife with errors. Anytime you receive a bill, ask the hospital or provider for an itemized bill that includes the billing codes of all the care you received. Next, check whether the billing codes are accurate. Again, simply Googling the codes with the phrase “medical billing code” can help. If something is off, contesting your bill with your medical provider or physician’s office can yield changes.

Another approach: comparing the bill with insurance companies’ estimates of fair charges for services. If the price you were charged is more than average, you can have your costs lowered.

Finally, compare your insurance company’s “explanation of benefits” to the bill. This explanation of costs covered and not covered must match the hospital’s bill.

Even after taking these steps, you can always appeal health claims with your insurance company.