FARGO — Medical bills are unlike most expenses because the consumer often has little or no control over spending that follows an illness or accident.

That’s very different from credit card debt, where a consumer’s lack of control usually plays a major factor, says Alicia Kellebrew, a certified financial counselor for The Village in Fargo.

Kellebrew sees an average of five clients per day who are struggling to pay their bills — at least one or two of whom are burdened with large medical debts.

She’s seen a “definite upswing” in clients struggling to pay their medical bills in the seven years she’s been a financial counselor, even with the passage of the Affordable Care Act.

Health insurance premiums have risen sharply over the years, Kellebrew said. Also, consumers’ out-of-pocket expenses in the form of deductibles and copayments have soared as employers and insurers have shifted much of the burden.

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Insurance plan deductibles of $1,500, $2,700 or even as high as $3,600 are now common, Kellebrew said. Those increasing health insurance premiums and deductibles, in turn leave consumers vulnerable to other costs.

“The premiums have gotten so high that people can’t afford to pay their other bills,” she said. “So it’s kind of a double-whammy.”

Although health conditions are often out of a consumer’s control, those struggling with high medical bills do have options, Kellebrew said. Here are some steps consumers can take:

  • Hospitals and clinics sometimes are willing to reduce bills, if presented with income verification, or can work out a payment plan, often without interest, she said.

  • Also, any hospital that is a nonprofit is required to provide a certain level of charity care, Kellebrew said. "That’s something I didn’t know until I started working here,” and something many consumers don’t know, she said.

  • Many consumers have the misconception, however, that paying a token amount toward a big bill, such as $20 per month, can keep their account out of debt collection. That’s not the case, Kellebrew said.

  • Regardless, consumers should promptly contact the hospital or clinic to try to work something out, instead of ignoring the bills as they pile up.

“It’s better if they just try to work with the hospital or clinic,” Kellebrew said. “You should be calling and asking for help. Let them tell you no.”

Tim Blasl, president of the North Dakota Hospital Association, said hospitals are willing to work with patients who have trouble paying their bills.

“I think all providers in the state are willing to work with patients,” he said. “There are programs in place to help individuals who are struggling with their medical bills. We understand this is a concern.”

Unfortunately, people who are struggling financially sometimes don’t take their medication or seek medical treatment, Kellebrew said.

“I’ve seen people who just forego medical treatment because they can’t afford it, she said. The high cost of insulin, for example, has caused some diabetics to miss doses, placing their lives at risk.

“You can’t neglect yourself to pay on debts,” Kellebrew said.

Health insurance premium increases have hit consumers, Blasl said.

“As premiums increase sometimes the insured are underinsured,” he said. But the Affordable Care Act, through Medicaid expansion and subsidies available to those who qualify who purchase insurance on the marketplace, have extended coverage to tens of thousands in the state, Blasl said.

“Our charity care-bad debt in the state has really decreased because of that,” he said. “In time I think we’re going to see a healthier population.”

A 2016 study by the North Dakota Hospital Association found that charity care was reduced by 40% or more after passage of the Affordable Care Act, Blasl said. That has strengthened the state’s health care system, he said, which benefits those who need medical care.

“I think it’s been good for the patient and the industry,” Blasl said.

Despite assistance available through the Affordable Care Act, many people still are hit with unaffordable medical bills, Kellebrew said.

That’s apparently because some employers responded to the law’s requirements by decreasing hours for employees, so they are no longer considered full-time and therefore do not receive benefits such as health insurance, she said.

“A lot of employees went to part-time positions,” and lost their insurance, she said. Even on the exchange, where some qualify for subsidies, “That’s still not cheap coverage,” Kellebrew said.