Get the insurers' rate. Medical care is like buying a car or going to college: Few people pay the actual sticker price. If you've ever had insurance, you've probably noticed that the amount your provider bills your insurer and what your insurer actually pays are quite different. That's because insurers have negotiated various discounts with these providers.

Ask your providers to discount your bills down to what the largest insurer in your area would pay for the same treatment.



"That's a reasonable expectation," Newsad said. "Your bill shouldn't be higher than what an insurance company would pay."

Ask for a cash discount. If you are able to pay a bill within 30 days, many providers will give you a substantial break on your total. You may get an even bigger discount if you can pay on the spot.

"My hospital offers a 79% discount at discharge" and even more if a patient pays that day, one of my Facebook fans wrote. "So a $1,000 (emergency room) bill is whittled down to $168. It's shocking how many patients refuse to pay even that."

You shouldn't, however, give in to the temptation to pay a big bill before you've investigated whether you qualify for financial assistance or other discounts.

Don't automatically reach for a credit card. Be wary of using a credit card to pay a medical bill, since a provider has no incentive to work out a payment program or offer you discounts after you pay the tab. 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.

By contrast, medical providers may offer 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.

Unfortunately, some medical providers have gotten into business with high-cost lenders who offer credit cards or installment loans with double-digit interest rates to pay for care. These are a last-resort option, if that. You certainly shouldn't agree to them before you've done your best to negotiate the bill as low as it can possibly be.

Ask your provider to take back a collection account. Here again, medical bills differ from other debt. Once a credit card account has gone delinquent, for example, the issuer typically writes off the debt and sells it to a collection agency. A borrower who's in a position to pay off the debt usually has to negotiate with the collector, rather than with the original lender. Medical debts, by contrast, are often collected on a commission basis -- in other words, the collector doesn't own the debt. The medical provider can take the debt back from the collector and negotiate directly with you. If your debts are very old, this may not be an option, but if you've incurred them in the past few years and are now able to pay, this is an option you should explore.

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If all else fails, 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. For more, consult an experienced bankruptcy attorney. The National Association of Consumer Bankruptcy Attorneys can provide referrals.

Liz Weston is the Web's most-read personal-finance writer. She is the author of several books, most recently "The 10 Commandments of Money: Survive and Thrive in the New Economy" (find it on Bing). Weston's award-winning columns appear every Monday and Thursday, exclusively on MSN Money. Join the conversation and send in your financial questions on Liz Weston's Facebook fan page.