I got a surprise $500 medical bill—how I could have avoided the shock

A few weeks ago, I tweaked my back putting weights on the rack at the gym. When things didn’t get any better after a week of rest, ice and ibuprofen, I decided to go to the orthopedist.

After sharing my medical history and the details of my injury with the nurse, I sat in the exam room goofing around on my phone waiting for the doctor. The next knock at the door wasn’t a physician, however, but a technician.

“Come across the hall for an X-ray,” she said.

“Oh good,” I should have thought. “They can get to the bottom of what’s wrong.”

Instead, I felt a pang of dread.

Earlier this year I was trying to sort out a skin condition and went to see an allergist. They told me they’d run the standard test where they prick you with 50 or so different allergens and see which ones you react to. It went well enough — it turns out I’m not allergic to much of anything.

A few months later, the bill for the test came in the mail. It was close to $500. Because I hadn’t hit my annual deductible yet, I was on the hook for the whole thing. I was pretty shook. Not once had any of the doctors I’d seen discussed that this procedure might be costly for me. They just ran the tests and scheduled me for a follow-up.

So when I returned to the orthopedist’s exam room having gotten my X-ray, still having not hit my deductible, all I could think was, “What did that just cost me?”

In hindsight, I shouldn’t have just quietly followed her. But refusing to go with the X-ray technician until she quoted me a price felt rude. Plus, how would she even know the cost? What you pay for any given procedure depends on your insurance coverage as well as rates your insurer has negotiated with the health-care provider’s billing office.

I’m not the only one recovering from health-care sticker shock. A 2024 study from private health-care foundation the Commonwealth Fund found that 45% of insured, working-age adults had received an unexpected bill in the previous year.

Your first step to avoid unexpected bills is to talk with your health-care provider. That may mean speaking up during a medical consultation, or having more involved conversations with your insurance company and your doctor’s billing department, says Carolyn McClanahan, a medical doctor, certified financial planner and founder of financial planning firm Life Planning Partners.

That can feel intimidating, especially if you’re on the spot, says McClanahan. You want to speak up for yourself and avoid surprise bills, but, if you’re like me, you don’t want to ruffle any feathers when you need care.

I still haven’t gotten the bill for my X-ray. But the discomfort I felt bringing up cost with the technician is a common phenomenon, says McClanahan. Nevertheless, it’s worth it to speak up and advocate for yourself both before and after your treatment, she says.

Talking with your provider beforehand can help you understand the costs of procedures and put you on a path toward treatment you can afford. And even if you need high-priced treatment, doing some research and putting in legwork around costs can help you avoid sticker shock down the line.

Here are three steps McClanahan recommends to avoid surprise bills.

Step 1: Communicate with your doctor

If you, like me, are put on the spot with a procedure of indeterminate cost, the first thing to do is ask your provider whether it’s really necessary, says McClanahan. You may find that there’s wiggle room on timing or cheaper alternatives to procedures or drugs the doctor recommends.

McClanahan suggests a possible script: “I have this really, really high deductible, and I’m trying to manage my bills. Can you please let me know what it’s going to cost or verify that I really need this now?”

Discussing your concerns with your doctor up front may help you get a treatment plan that’s more in line with your budget, she says.

Step 2: Do the best you can to shop around

Even if you have concerns about price, you may absolutely need a certain procedure. And if you haven’t yet hit your deductible in a given year, you’re likely going to have to pay up.

If you need to schedule a treatment at a later date, you can potentially save yourself some money by comparing costs at different providers, says McClanahan.

That means calling around to different medical providers in your area and asking their billing department what they charge for the treatment you want. Getting answers won’t always be straightforward, however, McClanahan says.

“The challenge is that every insurance company negotiates different rates,” she says. “The person sitting at the billing desk isn’t going to know off the top of their head what that rate is going to be.”

What’s more, what starts out as one treatment, like a colonoscopy, can turn into a pricier procedure if your surgeon discovers something concerning and has to perform biopsies, McClanahan says.

In other words, it may not be easy to pin down your medical provider’s billing department on an exact price. But do your best to explain to them that budget is an important factor when it comes to whether or not you’ll be able to receive treatment at their facility, McClanahan says.

Step 3: Investigate your bill

I still haven’t gotten the bill for my visit to the orthopedist. But when I do, I’d be smart to ask for an itemized list of charges, McClanahan says.

“You need to see what they’ve actually charged you for,” she says. “Then go on the internet and compare it with what’s actually a reasonable charge.”

McClanahan likes the search tool at FAIR Health, which shows estimated in-network and out-of-network costs for treatment based on what providers charge in your area.

If a bill you received is much higher than the average cost, or if your doctor’s office has tacked on charges that don’t seem to be in line with the care you received, call the billing department and plead your case, McClanahan says.

In the case of my allergy test, a medical provider would be unlikely to negotiate with me, McClanahan says. The price tag was in line with what providers in my area charge, and I was billed correctly.

In more extreme cases — say, ones in which a patient with a high deductible is facing down thousands of dollars in bills — medical providers may be willing to come down on costs, McClanahan previously told CNBC Make It.

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