A Texas boy’s second dose of the MMRV vaccine value over $1,400. A Pennsylvania girl’s long-acting contraception value greater than $14,000.
Therapy for a Florida Medicaid enrollee’s coronary heart assault value practically $78,000 — about as a lot as surgical procedure for an uninsured Montana girl’s damaged arm.
In 2025, these sufferers have been among the many tons of who requested KFF Well being Information to analyze their medical payments as a part of its “Invoice of the Month” sequence.
Insured and uninsured. Job-based and government-funded. Complete and short-term. A part of a sharing ministry. So many individuals with completely different medical health insurance conditions requested the identical questions: Why do I owe a lot? And the way am I going to afford it?
As hundreds of thousands of Individuals grapple with the rising value of medical health insurance subsequent yr, the “Invoice of the Month” sequence is approaching its eighth anniversary. Our nationwide crew of well being reporters has analyzed nearly $7 million in medical costs, greater than $350,000 of that this yr.
Of this yr’s 12 featured sufferers, 5 had their payments principally or absolutely forgiven quickly after we contacted the supplier and insurer for remark.
Our mission, although, is to empower each affected person with the knowledge wanted to grasp, handle, and — if push involves shove — battle their very own medical payments. Listed here are our 10 takeaways from 2025.
1. Most insurance coverage protection doesn’t begin instantly. Many new plans include ready durations, so it’s essential to take care of steady protection till the brand new plan kicks in. One exception: When you lose your job-based protection, you will have 60 days to decide into a COBRA coverage. When you pay, the protection applies retroactively, even for care acquired when you have been briefly uninsured.
2. Try your protection earlier than you verify in. Some plans include sudden restrictions, probably affecting protection for care starting from contraception to immunizations and most cancers screenings. Name your insurer — or, for job-based insurance coverage, your human assets division or retiree advantages workplace — and ask whether or not there are exclusions for the care you want, together with per-day or per-policy-period caps, and what you’ll be able to count on to owe out-of-pocket.
3. “Lined” doesn’t imply insurance coverage pays, not to mention at in-network charges. Fastidiously learn the high quality print on community hole exceptions, prior authorizations, and different insurance coverage approvals. The phrases could also be restricted to sure docs, companies, and dates.
4. Get a price estimate in writing for nonemergency procedures. When you object to the value, negotiate earlier than present process care. And should you’re uninsured and obtain a invoice that’s $400 or greater than the estimate, the federal Facilities for Medicare & Medicaid Companies has a formal dispute course of.
5. Location issues. Costs can fluctuate relying on the place a affected person receives care and the place checks are carried out. When you want blood work, ask your physician to ship the requisition to an in-network lab. A physician’s workplace related to a well being system, as an example, could ship samples to a hospital lab, which might imply increased costs.
6. When admitted, contact the billing workplace early. If potential, while you or a liked one has been hospitalized, it will probably assist to talk to a billing consultant. Ask whether or not the affected person has been absolutely admitted or is being saved underneath remark standing, in addition to whether or not the care has been decided to be “medically mandatory.” And whereas there could also be no selection about taking an ambulance, if a switch to a different facility is really helpful, you’ll be able to ask whether or not the ambulance service is in-network.
7. Ask for a reduction. Medical costs are nearly all the time increased than what insurers would pay, as a result of suppliers count on them to barter decrease charges. You may, too. When you’re uninsured or underinsured, you might be eligible for a self-pay or charity care low cost.
8. There’s assist out there for Medicaid sufferers. When you get a invoice you don’t assume you need to owe, file a grievance together with your state’s Medicaid program and, when you have one, your managed-care plan. Ask whether or not there’s a caseworker who can advocate in your behalf. A authorized help clinic or shopper safety agency specializing in medical debt can even assist file complaints and talk with suppliers.
9. Your elected representatives may also help, too. Whereas a name from a state or federal lawmaker’s workplace could not get your invoice forgiven, these officers typically have an open line of communication with insurance coverage firms, native hospitals, and different main suppliers — and advocating for you is their job.
10. When all else fails … you’ll be able to write to “Invoice of the Month”!
Most Insurance coverage Covers IUDs. Hers Price Extra Than $14,000.
By Julie Appleby,
January 31, 2025
The Reasonably priced Care Act requires most insurance coverage to cowl preventive care, together with many types of contraception, with out value to sufferers — however not in the event that they’re “grandfathered” plans, which predate the legislation.
A Runner Was Hit by a Automobile, Then by a Shock Ambulance Invoice
By Sandy West,
February 28, 2025
A San Francisco man had pals drive him to the hospital after he was hit by a automotive. Docs checked him out, then despatched him by ambulance to a trauma heart — which launched him with no additional therapy. The ambulance invoice? Virtually $13,000.
He Had Brief-Time period Well being Insurance coverage. His Colonoscopy Invoice: $7,000.
By Julie Appleby,
March 28, 2025
After leaving his job to launch his personal enterprise, an Illinois man opted for a six-month medical health insurance plan. When he wanted a colonoscopy, he thought it might cowl many of the invoice. Then he discovered his plan’s restricted advantages would value him a lot.
The Affected person Anticipated a Free Checkup. The Invoice Was $1,430.
By Samantha Liss and Lauren Sausser,
April 30, 2025
Carmen Aiken of Chicago thought their medical appointment can be lined as a result of the Reasonably priced Care Act requires insurers to pay for an extended listing of preventive companies. However after the appointment, Aiken acquired a invoice for greater than $1,400.
A Medicaid Affected person Had a Coronary heart Assault Whereas Touring. He Owed Virtually $78,000.
By Arielle Zionts,
Could 29, 2025
Federal legislation says Medicaid should cowl out-of-state emergency care. However a Florida man obtained a five-figure invoice after a South Dakota hospital declined to cost his state’s Medicaid program.
A Texas Boy Wanted Safety From Measles. The Vaccine Price $1,400.
By Julie Appleby,
June 30, 2025
A household dwelling in Galveston was stunned to be charged 1000’s of {dollars} for immunizations for his or her youngsters. Their insurance coverage plan didn’t cowl the pictures, and the price of the measles vaccine particularly was greater than 5 occasions what well being officers say it goes for within the personal sector.
A Vacationer Ended Up With a Wild Bat in Her Mouth — And Almost $21,000 in Medical Payments
By Tony Leys,
July 31, 2025
Medical health insurance typically doesn’t cowl therapy for accidents sustained shortly earlier than a buyer buys a coverage. A Massachusetts girl discovered that out the laborious approach.
An Insurer Agreed To Cowl Her Surgical procedure. A Politician’s Nudge Bought the Payments Paid.
By Cara Anthony,
August 26, 2025
A kindergartner in Missouri wanted eye surgical procedure. Her insurer granted approval for her to see a specialist close by, but her mother and father have been confused once they nonetheless owed greater than $13,000. Then her uncle, a former state senator, reached out to a colleague who contacted the hospital and the insurer.
She Had a Damaged Arm, No Insurance coverage — And a $97,000 Invoice
By Katheryn Houghton,
September 24, 2025
Deborah Buttgereit knew piecing collectively the damaged bone in her elbow can be costly. However problems the physician deemed a shock, midsurgery, drove the entire invoice tens of 1000’s of {dollars} above the unique estimate.
Physician Tripped Up by $64K Invoice for Ankle Surgical procedure and Hospital Keep
By Julie Appleby,
October 29, 2025
A physician in Colorado turned the affected person after an accident totaled her automotive and despatched her to the working room. The hospital saved her in a single day, however her insurer stopped paying after she left the emergency room.
Not Severe Sufficient To Activate the Siren, Toddler’s 39-Mile Ambulance Journey Nonetheless Price Over $9,000
By Tony Leys,
November 25, 2025
After her son contracted a critical bacterial an infection, an Ohio mom took the toddler to a close-by ER, and staffers there despatched him to a youngsters’s hospital in an ambulance. With no insurance coverage, the household was hit with a $9,250 invoice for the 40-minute trip.
Scorpion Peppers Triggered Him ‘Crippling’ Ache. Two Years Later, the ER Invoice Stung Him Once more.
By Elisabeth Rosenthal,
December 19, 2025
Home made sizzling sauce despatched a Colorado man to the emergency room with what he known as “the worst ache of my life.” However abdomen cramps have been solely the start. Two years later, the invoice got here.
Photographers
Jason ArdanScott DaltonLoren ElliottJamie Kelter DavisMatt KileJacob Langston
Maddie McGarveyParker Michels-BoyceSophie ParkJim VondruskaJeremy Wade ShockleyRachel Woolf
Invoice of the Month is a crowdsourced investigation by KFF Well being Information and The Washington Publish’s Properly+Being that dissects and explains medical payments. Since 2018, this sequence has helped many sufferers and readers get their medical payments decreased, and it has been cited in statehouses, on the U.S. Capitol, and on the White Home. Do you will have a complicated or outrageous medical invoice you wish to share? Inform us about it!
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