What happens when you can't pay your medical bills?

It's no secret that health care costs have been spiraling out of control for years. To fight back, your best bet is to be a well-informed consumer: Know the true costs of medical procedures, supplies and medications so you can bargain effectively; carefully anticipate and track medical expenses; and stay on top of your bills.

But sometimes, even when you follow the rules you still can get burned. I've heard many appalling stories about people – even those with comprehensive insurance – who have been denied benefits, over-charged, sent to collections or even forced to file for bankruptcy because they couldn't pay their medical bills.

Here are a few coping strategies:

Carefully review each doctor, lab or hospital bill and match it against the Explanation of Benefits statement that shows how much they were reimbursed by the insurance company. Also, watch for items that may have been charged to you by mistake such as:

• Medications, supplies, treatments or meals you didn't receive while hospitalized or getting an outpatient procedure.
• Duplicate charges for a single procedure (such as x-rays, MRIs and lab work), including those that had to be redone due to a technician's error.
• Charges for a full day's hospitalization when you checked out early; or private room rates when you shared a suite.

The summary hospital bill you were sent probably doesn't contain many details, so ask for an itemized bill along with a copy of your medical chart and a pharmacy ledger showing which drugs you were given during your stay.

If you're having difficulty paying a medical bill, don't simply ignore it. Like any creditor, doctors and hospitals often turn unpaid bills over to collection agencies, which will wreak havoc with your credit score. Contact creditors as soon as possible, explain your situation and ask them to set up an installment payment plan or work out a reduced rate.

Many people with no insurance discover that they're often charged much higher rates than those negotiated by insurance companies, Medicare and Medicaid. Don't be afraid to ask for those lower rates and to work out a repayment plan – just be sure to get the agreement in writing. Most doctors and hospitals would rather accept reduced payments than have to deal with collection agencies and possibly no reimbursement at all.

Ask the hospital's patient liaison to review your case and see whether you qualify for financial assistance from the government, a charitable organization or the hospital itself. Most will forgive some or all bills for people whose income falls below certain amounts tied to federal poverty levels. Also pursue this avenue with your doctor or other provider – ideally before they've begun collections.

A few additional cost-savings tips:

• Ask whether your employer offers flexible spending accounts, which let you pay for eligible out-of-pocket health care and/or dependent care expenses on a pre-tax basis.
• Use online price-comparison services like Healthcare Blue Book and OutofPocket.com to research going rates for a variety of medical services.
• Unless it's a true emergency, try to avoid emergency rooms and use an urgent care network facility affiliated with your insurance company or ask your doctor for recommendations.

Bottom line: Know what health services cost and don't be afraid to negotiate. You'll haggle over the price of a car – why not your health?