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Facing huge medical bills can be frustrating and stressful. Whether you lack insurance altogether or simply have poor coverage, it can take one illness, accident, or major life event to send you spiraling into a black hole of medical debt. If you are facing four- or five-digit medical bills (or worse), it can be very tempting to let the calls from collectors go to voicemail or off the hook, considering that you know you don’t have enough to give them. Unfortunately, these people are often just trying to help you. I recently read a Liz Weston column on MSN Money having to do with haggling over medical bills in order to pay off what you owe. Considering that we mostly do not live in a haggling society and consequently don’t have these skills on a native level, I thought the article and its contained advice was very interesting!

Weston quotes former surgery center administrator Nicholas Newsad, who wrote a book recently called “The Medical Bill Survival Guide: Easy, Effective Strategies for People Experiencing Financial Hardship.” His tome is aimed at those who are trying to deal with medical debt. He has some experience with this topic, considering that he used to be the person on the other end of several collections calls. He says that many patients would simply refuse to talk to him when he called, either not answering or hanging up. Newsad calls this ironic, since the center actually had tools at its disposal to help patients – think financial assistance and lenient policies. When patients don’t answer the phone, however, they don’t give people like Newsad a chance to help them. Newsad, who now works for a healthcare appraisal company, points out that medical debt is very different from regular debt, and that it can often be dealt with on a level that many people wouldn’t expect.

Here’s what you need to know about medical debt: many people are able to cut it back dramatically or even eliminate it altogether, thanks to financial assistance from their debtors. Most people are able to negotiate massive discounts off the sticker prices of treatments and tests, simply by asking. When balances can’t be stricken altogether, many healthcare providers offer no-interest payment plans tailored to your income and personal situation. And, as a last resort, know that, even at the point of collections, you may have more options related to your medical debt than you might think!

If you are facing a mountain of medical bills so high that you could never reasonably pay them off, know that you can probably get a much better deal if you try. For one thing, did you know that a LOT of medical bills have at least one error? Hospital bills are prime offenders in this regard. Hospitals can – and do – charge for procedures that were never done, doctors visits that never took place, and even medicine that you never took! That’s why it’s so important to demand an itemized bill from your hospital and review it line by line when facing a seemingly insurmountable bill. A good resource for determining the fairness of charges is the Healthcare Blue Book, a free consumer guide. If you do find errors, you need to bring them to the attention of the hospital’s billing department.

Weston says that she has anecdotal evidence herself of this being true. A friend of hers gave birth in a hospital recently, and claims to have been charged mistakenly in several areas on the bill. Her bill contained charges for pain medications and sleep aids that she never took, an a bit of other “dubious stuff,” as she termed it. A visit to the hospital billing office earned her a line-by-line review during which several things were stricken from the bill.

Know that, just because you don’t get a bill after a visit to a doctor or other medical provider that doesn’t mean that you are off the hook. The provider If you don’t receive a bill, there is a chance that the hospital or provider may be sending the bill to the wrong address or billing the wrong insurer. This is not your fault, but you will still owe the balance outstanding. Consequently, the bill could be turned over to collections without your knowing, and collections can hurt your credit scores. Don’t assume that no news is good news. If you haven’t been billed or you keep getting billed for something your insurance should have paid, follow up to find out what’s going on, and try to fix it before the bill ruins your credit. You do have a burden of due diligence when it comes to money owed for services rendered.

Let’s say that you have a huge hospital bill, and have already checked it through for errors. At this point, it may be worth your money to hire someone to help you review the charges and negotiate discounts. Yes, it will cost money that you feel like you don’t have. Still, you could save a LOT more money than you spend. Weston recommends three such companies for this kind of help – Medical Cost Advocate, Health Advocate and Chapman Consulting. As far as do-it-yourself assistance goes, consider the possibility of charity care, which most hospitals and many other providers offer. This might be an option if your income is low. If you believe that you could qualify for such aid, ask to speak to a financial counselor at the institution where you owe money. The federal poverty line is often the cutoff for charity care, which currently works out to about eleven thousand dollars for a single person or twenty-two thousand three hundred fifty dollars for a family of four. If you make less than twice the poverty line cutoff, you could have your whole bill erased. Weston says that this is actually common. Newsad confirms this, reporting that those single making as much as twenty-two thousand dollars or families making as much as forty-five thousand dollars could have their whole debts excused. Period.

Don’t think that making too much will excuse you from big discounts, either. If you make three hundred percent of the poverty cutoff, you could get seventy-five percent off your bill(s). Make four hundred percent of the limit? You could still get half off. It’s not surprising, but your medical providers may not volunteer that such help is available. You often have to ask. After all, why would these doctors and hospitals volunteer to give away free money, which is essentially what these programs amount to? Even if your provider doesn’t offer financial assistance or you make too much to qualify, discounts are still available, however. Don’t give up hope just yet!

Here’s an idea for the bold: ask the hospital or doctor for the insurers’ rate for the services or tests you had. Keep in mind that medical care is very much like college tuition or buying a car: the sticker price is almost never the final bill. Most people get some sort of a discount. If you have insurance or ever have in the past, you will notice that the amounts your provider bills your insurer and what your insurer actually pays are quite different. In fact, they can be staggeringly different! That’s because insurers have negotiated various discounts with these providers, and don’t pay the “sticker” price. Therefore, it is only fair for you to ask your provider(s) to cut you a break to the tune of the same discounts that the largest insurer in your area would get for the same treatment. Newsad confirms that this is “reasonable” and points out that you shouldn’t have to pay more than what an insurance company is willing to pay.

Okay, so you have haggled that price down as low as it can go. You aren’t done yet. Ask the hospital and/or providers for a cash discount. Are you able to pay the bill within thirty days with cash? (And you just might, after so many breaks!) If so, you can expect a pretty substantial discount off your total. If you can pay on the spot, you can demand an even heftier discount. A Facebook fan of Weston’s claimed to have been offered a seventy-nine percent discount at the point of discharge – with the possibility of even more – if a patient can pay the same day. If you have a one thousand dollar emergency room bill, that’s over eight hundred dollars knocked off the bill just because.

Even if you have the money to pay a big bill, you shouldn’t do so until you have investigated the options for deeper discounts. First of all, NEVER go straight for a credit card. You should try hard to avoid paying a medical bill with plastic, since the hospital or doctor in question has zero incentive to help you gradually pay down your debt once you have paid the bill. Once you’ve charged the bill, you’ll be subject to the credit card’s interest charges and vulnerable to credit score damage if you can’t make the payments on time. If you stick with the medical bill, on the other hand, you may be able to tap into interest-free repayment plans if you can pay off the bill within two years. Also, medical payment plans typically aren’t reported to the credit bureaus, although if you miss payments the account may be turned over to collections, which could hurt your credit.

One pitfall to watch out for nowadays is the medical provider who has climbed into bed with lenders of high-cost credit cards and/or installment loans aimed at those who can’t pay for care. I know personally that CareCredit is one such card. These loans and accounts have double-digit rates of interest. Therefore, they should be considered a last-ditch resort and avoided at all reasonable costs. At the very least, please don’t go down this road until you have already exhausted all your options for driving the bill down as low as it can possibly go. You may be shooting yourself in the proverbial foot with regards to your ability to repay debt in a timely and realistic manner.

Here’s another option you have with delinquent medical bills that just isn’t possible with normal debt: if you have an account in collections, you can ask your hospital or provider to take back an account in collections. Although a credit card in collections is considered irredeemably delinquent, normally with the debtor having already written off the debt in question, hospitals seldom sell their debts to collection agencies. Instead, they are frequent collected on a commission basis. The collector does not own the debt, and the original debtor can redeem the debt at any point. This means that you can go back to the hospital or doctor and negotiate directly with them, even if the account is in collections. True, you may be past this option if your debts are very old… but if you’ve incurred them in the past few years and are now able to pay, this is an option you should explore. It can’t hurt to look into matters and make some inquiries.

If you have looked into all these options and still have more bills than you can pay, that might be the time to consider bankruptcy. Medical debt, like credit card debt, can be wiped out in a Chapter 7 bankruptcy or be part of a Chapter 13 repayment plan. If your health problems are continuing, you should probably hold off on filing, since you can’t have debt erased more than once every eight years. This might be the case for a family stricken with a disease like cancer, which requires ongoing, very expensive treatment and hospitalization. It’s true that bankruptcy is a last ditch gamut, but for some people, it is the best and only option. For more, consult an experienced bankruptcy attorney. The National Association of Consumer Bankruptcy Attorneys can provide referrals on the basis of your specific situation, including volume of debt and number of debtors.