4 surprising medical costs to watch out for, and how to avoid them

• Surprise medical bills are common in the US, especially for services like ambulances and childbirth.
• Free cancer screenings may also come with follow-up costs, and cancer is a top cause of debt.

When Ronald Barajas developed a fever, shakiness, stomach pain, and a loss of appetite in 2021, he thought he had COVID-19.

But his daughter urged him to go to the emergency room, where Barajas, a 65-year-old in Baytown, Texas, learned his appendix had ruptured, according to the charity organization Dollar For. The condition is considered a medical emergency, and Barajas needed his appendix removed to treat it.

While Barajas's insurance covered most of the $85,000 bill, he was still responsible for $9,800 — a startling amount for the recent retiree. "I ended up with around $6,000 in debt on a payment plan," he told Dollar For. "Certainly, that didn't help my situation."

While Dollar For, which advocates for patients with untenable hospital bills, eventually helped resolve Barajas's debt, receiving surprising medical bills is common in the US.

Despite a 2022 federal ban on certain surprise medical bills, like those for emergency services, 1 in 5 Americans reported receiving an unexpected medical bill in the last year, according to a 2022 survey from Morning Consult. Over one-fifth of them were charged more than $1,000.

The lesson: "Consumer beware," Dr. Mark Fendrick, director of the University of Michigan's Center for Value-Based Insurance Design, told Insider. More specifically, beware of the following common surprise medical costs — and learn how to avoid them.

1. Ambulance rides

Even patients with insurance can be charged between $500 and $1,000 for an ambulance ride, according to a 2022 report from the Public Interest Research Group. "Ground ambulances are the highest out-of-network biller of all of our health care services," Patricia Kelmar, PIRG's senior director of health care campaigns, told CBS MoneyWatch.

Billing differs widely by city and state, as ambulance services can be run by various institutions including hospitals, fire departments, and private equity firms, CBS reported.

But patients can sometimes reduce or eliminate an ambulance bill by seeing if the company has a financial assistance program like American Medical Response's Compassionate Care Program, Jared Walker, Dollar For's founder, told Insider. "If you don't ask for it by name, they won't tell you about it," he said.

2. Childbirth

Raising a child in the US is notoriously expensive, but delivering one can be surprisingly costly too — especially if you're uninsured.

Pregnancy, childbirth, and postpartum care cost nearly $19,000 on average without insurance, according to the Peterson-Kaiser Family Foundation Health System Tracker.

For people with insurance, the typical out-of-pocket cost is still around $3,000, and can be more if the mom or baby need more intensive follow-up care, "which is just so, so sad," Fendrick said.

Walker told Insider that about 15% of people who reach out to his organization are seeking financial relief from childbirth expenses.

One key way Dollar For helps is by navigating hospitals' charity care policies, or the programs in all nonprofit and some for-profit hospitals that reduce medical bills for lower-income families. Anyone can see if they're eligible — whether after childbirth or any other hospital visit — by plugging their bill amount, income, and the hospital name into Dollar For's tool.

"The number one resource is charity care," he said. "If you get a big hospital bill, you might not have to pay it."

3. Follow-up cancer screenings

The Affordable Care Act makes certain cancer screenings, like breast and prostate, free. But in some cases, the follow-up tests for abnormal results is not, Fendrick said.

"This infuriates me," he said. "They're telling people that your cancer screening is free, and then the people who are benefiting from that screening are the ones who have to pay."

While Fendrick and colleagues are pushing for policies changes to address this, the best thing patients can do is to know what they're getting into upfront: Ask your insurance company or the hospital about whether just the screening is covered, or if follow-up procedures are covered, too.

4. Cancer treatment

According to a KHN-NPR investigation, cancer is a top driver of medical debt for Americans, leading about a quarter of survivors and family members of cancer patients to declare bankruptcy or lose their home.

"A medical crisis shouldn't mean a financial crisis," Walker said. "And a lot of times people are stressing about the bills when they should be stressing about their health."

Here, too, patients can look into charity care programs or organizations like the Patient Advocate Foundation, which helps resolve insurance problems and provide financial support. There are also charities for specific types of cancer, like PinkAid for breast cancer financial support.

How to tackle any surprise medical bill — and win

Even if families make too much money to qualify for charity care programs, Walker says there are a few go-to tactics that anyone can use, regardless of diagnosis or financial status, to tackle surprise medical bills and try to lower medical costs.

First, call the hospital billing department and ask, "What is the settlement amount?" This means, "What sort of discount will you give me if I pay the bill right now?"

"A lot of times we can get, at the very least, 30% off just by agreeing to pay an amount up front," Walker said. The hospital "wants to close that account just as much as you do." If you don't get a satisfying answer the first time, try again the next day. "Don't panic," he said.

He also recommends always asking for an itemized bill. Because medical bill errors are common — some sources estimate that between 30% and 80% of bills contain errors — seeing the breakdown can help patients spot charges worth disputing.

For example, a condition may have been coded as more severe than it was, or a treatment may have been included that was never delivered. Sites like Healthcare Bluebook can help patients compare their charges against other institutions, too.

The effort often pays off: While a recent survey showed most people have never disputed a medical bill, 78% of those who have disputed a bill have successfully gotten it reduced. For some people, that can be the difference between good and bad credit, or continuing your education or not, Walker has found.

"If you can take that burden away from people," he said, "imagine all the good that they're able to do because they don't have to deal with the medical bill that wasn't their fault."