Frequently Asked Questions

When it’s an emergency—Call 911 or bring your child directly to an emergency department in an acute care hospital, not a local urgent care center. Hospitals are required to provide you with emergency care, even if you don’t have insurance. While you are at the hospital, request to see a social worker who can help determine if your child is eligible for New Jersey Family Care. In addition, also request an application for Charity Care before you go home because you may be eligible for free or discounted care if your income is below 500% of the Federal Poverty Level or FPL.

When it’s not an emergency—Contact a Federally Qualified Health Center (FQHC) using the list contained in Appendix A to the Manual (available on this website). The FQHC will treat your uninsured child and will help determine whether your child is eligible for New Jersey Family Care and, if so, will help you apply.

When it’s an emergency—Call 911 or find someone to bring you directly to an emergency department in an acute care hospital, not a local urgent care center. Hospitals are required to provide you with emergency care, even if you don’t have insurance, unlike urgent care centers. While you are at the hospital, ask to see a social worker who can help determine if you are eligible for Medicaid or New Jersey Family Care. Request an application for Charity Care before you go home because you may be eligible for free or discounted care if your income is below 500% of the Federal Poverty Level or FPL.

When it’s not an emergency—Contact a Federally Qualified Health Center (FQHC) using the list contained in Appendix A of the Manual (available on this website). The FQHC will treat you and will also determine whether you are eligible for Medicaid or New Jersey Family Care and, if so, will help you apply.

When it’s an emergency—Call 911 or find someone to bring you directly to an emergency department. State law requires that all providers bill you at the in-network rate when you are receiving emergency services. If you have not yet paid your insurance deductible for the year, then you will be responsible for paying that before your insurance coverage kicks in, along with any co-pays. If you are worried about being able to afford the deductible and other costs, request an application for Charity Care before you go home. You may be eligible for free or discounted care if your income is below 500% of the Federal Poverty Level or FPL.

When it’s not an emergency—Use our Manual (at Chapter One, Section 1) to understand the terms of your insurance. Then, find a provider in your insurance network and make an appointment with them. If you have not yet paid your insurance deductible for the year, you will be responsible for paying that before your insurance coverage kicks in, unless you are receiving the fully-covered preventive services discussed next. If you are worried about being able to afford the deductible all at once, you may be able to negotiate a Payment Plan with the physician’s office. This is different from using a medical credit card or third-party payment plan to pay for the services, which we do not recommend for reasons discussed in Chapter One, Section 4, under the heading “Paying Your Medical Bill.”

When it’s for preventive services—Preventive services include health care such as immunizations, blood pressure and cholesterol screenings, mammograms, and colonoscopies. You can receive these services for free even if you have not yet met your yearly deductible and you cannot be charged a co-pay.

Speak with the primary care doctor who recommended you have the surgery and ask them for a referral to a hospital or associated ambulatory surgical center that will provide you with discounted or free Charity Care. Because you do not have insurance, you are entitled to a Good Faith Estimate of what it will cost you. Good Faith Estimates are discussed in Chapter Two, Section 2 of the Manual. Also, hospitals are required to post their prices online which makes it possible to “shop around” for a hospital that charges less, using the NJ Hospital Price Compare website.

Know the terms of your insurance—Use our Manual to understand the terms of your insurance coverage, which are discussed in Chapter One, Section 1. Find out if you need prior authorization for the surgery or specialized treatment and if so, obtain such approval from your insurer and discuss with them the scope of coverage and how much it is expected to cost you. Then, find a provider in your insurance network and make an appointment. Confirm with your insurance company that the hospital, specialist, anesthesiologist and anyone else expected to be involved with the surgery or treatment is in-network.

The first thing to do is to contact your local Federally Qualified Health Care provider. A list of NJ FQHCs is provided in Appendix A of the Manual. They will provide you with prenatal care and enroll you in the New Jersey Supplemental Prenatal and Contraceptive program (NJSPCP), if you are income eligible. The NJSPCP is operated by NJ FamilyCare and it provides prenatal and family planning services to women who do not qualify for NJ FamilyCare because of their immigration status. NJSPCP does not provide complete healthcare coverage, such as hospital visits or labor and delivery.

For the actual delivery, you have to seek such care in an acute care hospital. In addition to applying for Charity Care, the State has a Medical Emergency Payment Program, which covers emergency services, including labor and delivery, for New Jersey residents age 19 and older who do not qualify for NJ FamilyCare because they do not meet the U.S. Citizenship or Immigration requirement (which requires a legal immigrant to be residing in the country for at least 5 years before being eligible for Medicaid).

Ask if you have met your deductible. Determine if the up-front payment you are being asked to make is just the co-pay and if it is, you should pay it.

If it’s the deductible and/or co-insurance, you should not have to pay it prior to treatment. If the provider insists and you cannot afford to pay, discuss it with the provider and try to negotiate a payment schedule. If you are in a hospital, ask for a Charity Care application (even if you are insured).

Enter into negotiations with the provider to lower the amount of total payment for the treatment or at least the up-front amount so that you can obtain the treatment. One option is to agree to a Payment Plan that will allow you to pay for the treatment in affordable, multiple installments over a period of time.

Be aware that if you opt to pay with a regular credit card and you are unable to make the payments, the unpaid debt can be reported to credit reporting agencies and hurt your credit because the state law that prohibits medical debt from being reported does not apply to credit cards. The law does protect you if you use a special credit card meant for medical debt UNLESS you use that same card for other expenses such as spa and wellness care or veterinary expenses.

If you are insured, make sure it is a bill sent by your health care provider and not an Explanation of Benefits sent by your insurer. The difference between the two is explained in Chapter Three, Section 1 of the Manual. Whether you are insured or uninsured, make sure the bill is accurate and that you received the services described. If it seems incorrect or you are unsure about anything, contact the health provider (usually their billing office) and ask them to go through the bill with you and explain anything that is unclear. Once you know enough to form an opinion that the bill or its amount is incorrect, or that you do not owe it for some other reasons, you can use the form letter in Appendix D-1 to dispute the bill.

Once you have ascertained that you received the services described in the bill and that the bill is otherwise accurate, you can try to negotiate a Reasonable Payment Plan to pay the bill in a series of monthly installments. Under a state law taking effect on July 22, 2025, providers are legally obligated to offer you such a Plan, which can last up to 5 years, with payments no more than 3% of your monthly income and interest capped at 3%. Reasonable Payment Plans are discussed in detail in Chapter 3, Section 2 of the Manual and Appendix D-2 of the Manual contains a form letter for negotiating a Reasonable Payment Plan.

If you are uninsured, you are likely be billed at a higher amount than an insured patient, because you did not receive the discounted rate that an insurer negotiates from providers. You can try to negotiate your own lower rate based on the Medicare rate for each procedure on the bill. To do so, you will have to obtain from the provider the five-digit Healthcare Common Procedure Coding System (HCPCS) code, also known as the Current Procedural Terminology (CPT) code, for each service or procedure billed, You can use that code to look up the Medicare rate—also known as the Physician Fee Schedule or PFS—on this website and then offer to pay that amount instead of the billed amount, telling them your offer is based on the Medicare rate. If you cannot obtain the code, then you can try offering 20% of the billed amount, which is roughly equal to the Medicare rate. Either way, even if the provider does not agree to go as low as the Medicare or 20% rate, they might still be willing to reduce the bill. Whether or not they reduce the bill, as of July 22, 2025, they are required by to offer you a Reasonable Payment Plan, which can last up to 5 years, with monthly payments no more than 3% of your income and interest capped at 3%, as discussed in Chapter 3, Section 2 of the Manual. Appendix D-2 contains a form letter for negotiating a Reasonable Payment Plan.

The most important is that when debt collectors come after you, DO NOT IGNORE THEM, which increases your chances of being sued, even if the debt is expired or otherwise not valid.

You should also know that state law does not allow debt collectors or health care providers to start trying to collect medical debt until 120 days after the first bill has been sent and until after any insurance coverage issues have been resolved, including an appeal from a denial of coverage or the amount of it. Debt collectors, like health providers, are also required to first offer you a Reasonable Payment Plan, as discussed in Chapter Three, Section 2 of the Manual. Once all those requirements have been met, debt collectors (and health care providers as well) must send you one more bill that notifies you that if you do not pay by a specified deadline at least 30 days from then, they will start debt collection activity against you and must state what kind of action they will take.

Once a debt collector starts debt collection activity, a federal law known as the Fair Debt Collection Practices Act (FDCPA) requires that if you ask them to verify the debt within 30 days, they must halt debt collection efforts until they provide you with certain information, including the name of the creditor, any account number associated with the debt, the current amount of the debt as well as an itemization that reflects interest fees, payments and credits and how to reply to the debtor if you dispute the debt or its amount. This is known as debt validation and it is especially important when it is not the health provider, but someone who has bought the debt from them or a debt collector who is trying to collect it. Under such circumstances, it might not be clear what the bill is for or when it was incurred, which makes it difficult to know if you should pay it or contest it. Once they provide validation, you have 30 days to dispute the debt or it is deemed valid. Appendix D-1 is a form letter that can be sent to a debt collector as well as to a health provider disputing a medical debt and it lists possible defenses. Those include that the debt was reported to a credit agency in violation of state law, in which case it automatically becomes void and no one can sue you for it or that the debt is older than six years and has thus expired. NOTE in many states, if the debt has expired and you make any payment on it after that or acknowledge that the debt is valid, it reactivates the debt and starts the six-year clock running all over again for them to sue. However, under binding New Jersey case law, Midland Funding LLC v. Thiel, 446 N.J. Super. 537 (App. Div. 2016), partial payments on a defaulted credit card account does not restart the running of the time to sue whether that payment is made before or after the statute of limitations on the debt has expired.

The FDCPA also limits what debt collectors can do to try to collect the debt with regard to how, when and where they can contact you, as discussed at length in Chapter Four, Section 2. (Note that the FDCPA does not apply to the doctor or hospital that provided the services, only to debt collectors.)

KEEP IN MIND that if the debt was reported to a credit agency in violation of state law, it becomes void and no one can sue you for it. Or if the debt is older than six years, it has expired and they an try to collect it but cannot sue you for it.

Review the court papers and take note of any deadline to respond and make sure to respond by that date because if you miss the deadline, it can result in a default judgment against you, even if you do not owe the debt and could have defeated the lawsuit. If you need extra time, you can ask the plaintiff suing you for such time, and if they refuse, you can ask the court. If at all possible, get an attorney to advise you on how to proceed and help you defend the lawsuit, Appendix C provides information on how to find legal help, including free legal help if you meet the financial criteria.

In the absence of a lawyer, you will have to determine on your own whether the plaintiff who is suing you has a valid claim and what defenses you might have to defeat the claim entirely or reduce the amount claimed. For example, if the debt was reported to a credit agency in violation of state law, it becomes automatically void and no one can sue you for it. Or if the debt is older than six years, it has expired and can no longer be sued on. Chapter 4 Section 3 of the Guide/Manual contains detailed information about the many possible defenses that might be available to you and about how to handle the lawsuit—from filing an Answer to the Complaint, to preparing for trial, defending yourself at trial and appealing if you lose. It also discusses the bankruptcy options. Appendix D-3 is a form for filing an Answer to a medical debt lawsuit that lists the possible defenses and Appendix D-4 is a form called a Certification of Service, that must be filed with the Answer showing that you served a copy of it on the opposing side.

The key fact to keep in mind is that the No Surprises Act does not apply to ground ambulances (only air ambulances) and if the ambulance that shows up turns out to be not in-network, you could get hit with a pricey out-of-network bill. There is nothing you can really do, but hope you get lucky and the town from which you are calling 911 provides Emergency Medical Services (EMS) or emergency ambulance transport and has agreed not to Balance Bill any insured patient beyond co-pays or co-insurance, as some towns have done. What you CAN control is when an ambulance service is needed to transfer you or a family member between hospitals: you can make sure the ambulance service used for that purpose is covered by your insurance.