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Medical procedures in the United States are breathtakingly expensive. A heart catheterization is typically $50,000 to $100,000. Anterior cervical discectomy and fusion (ACDF) might cost $25,000 to $50,000. Inguinal hernia repair might cost a mere $5,000 to $10,000 for the surgeon's bill, but another $10,000 for surgical room and anesthesiologist fees (and that's for treatment as an outpatient). Hospital rooms cost $5,000 to $10,000 a day with every service resulting in an additional, substantial fee. What are Americans to do?

The simple answer is to get health insurance. Even a policy that does not cover the cost of a procedure can still save the person who is insured a great deal of money. How can that be? Insurance companies negotiate with doctors, hospitals, and drug companies for lower prices. If you are covered by insurance at all, you will be charged the same price that the insurance company has to pay. You may have a $6,000 to $10,000 deductible so that the insurance company pays nothing, but the amount you do pay may be 50 percent, 60 percent, or even 90 percent lower than if you had no insurance at all. 

Since 2014, health insurance companies are no longer allowed to refuse coverage to people who have preexisting conditions or to impose a cap on the amount they pay for your care. Insurance companies cannot make anyone wait to get coverage for a preexisting condition. The younger you are, the lower your premiums will be. Even without Obamacare subsidies, someone who is 25 years old might pay as little as $50 a month for a policy with a huge deductible. So if you know someone who has to have a surgical procedure, making a small investment for even one month's coverage with even a high-deductible policy can save a huge amount of money, even if the insurance company pays out nothing at all. And if there are complications, then the cost of care will be covered.

If you will do this much, then hospital financial aid offices will be much more inclined to help you with the rest. Generally hospitals appreciate patients who speak with financial aid offices before they have their procedures. They appreciate patients who are open and honest about their financial resources, or lack of them. Hospitals don't usually try to collect exorbitant amounts of money for their services, and usually don't report unpaid balances to credit bureaus as long as the patient is making at least a small, agreed-on payment. They will usually give you the same discount they give insurance companies if you ask, and sometimes even if you don't.

There are foundations and grant programs that sometimes cover the cost of health coverage. The hospital will know about all of them. Sometimes the hospital itself has a charitable fund for people who are in need, but don't suppose that you are necessarily the neediest person on their list. If you are asking for generosity, approach the hospital with honesty and humility. You are, after all, asking for someone you don't even know to pay your bills.

Government programs to help with medical bills tend to be a lot less than generous in the United States. States may impose absurdly low income limits for Medicare assistance, less than $200 a month in many states that have not elected to go with Obamacare expansion. Indigent care programs will typically require that you not have assets other than a house or a first car and your clothes and furniture that have a value of over $2000. A second car, a retirement account, or any luxury item usually makes you ineligible. Even if you are sleeping on someone else's couch, the state may consider the value of couch hopping to be equivalent to a free hotel or motel room, making you ineligible for state assistance. Your best option is always to get any insurance coverage you can, and then to work patiently and politely with the hospital itself.

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