Medical debt is the primary cause for bankruptcies in the United States. The Balance summarizes several data sources on bankruptcies, including a Harvard study claiming medical bills caused 62.1% of all bankruptcies in 2009. That’s 877,372 people who filed bankruptcy because they couldn’t pay for necessary medical care. Although the total number of bankruptcies has since fallen from 1.4 million, the numbers still don’t look good. As of March 2018, bankruptcies totaled 779,828. 

Regardless of a decline in bankruptcies, medical bills are expensive. If you’re injured in a car accident, and you don’t play the right cards, medical debt can ruin your life. 

Here’s how to avoid having to file bankruptcy after an expensive recovery:

1. Take your pain and suffering seriously

Push past any aversion you have to being compensated for pain and suffering. Pursuing compensation for pain and suffering seems like an excuse to get more money, but it’s not. After being injured in a car accident, you’re going to feel a wide range of emotions that can impact your ability to function in the world. For example, car accident victims can develop PTSD and may never drive a car again. You might panic at stop lights if that’s where you were hit. Or, you might only be able to drive during the day, which will severely limit your job opportunities.

PTSD and anxiety are invisible injuries that aren’t generally covered under regular medical expenses. These psychological injuries often show up later on. If you need any kind of therapy to help with PTSD or anxiety, you’re going to pay for that out of pocket. The only way to make sure your psychological wellbeing is covered is to pursue compensation for pain and suffering. When you’ve been injured, you deserve it. 

2. Don’t accept the first settlement offer

Insurance adjusters are for-profit corporations. They’ll do anything to keep money in their pocket, including lowball your settlement offers. 

The first offer you get won’t be enough to cover your expenses. Insurance adjusters will always toss out the lowest possible offer in hopes that you’ll take it. You need to negotiate your settlement. However, keep in mind that adjusters have a maximum amount for each claim, and even the most skilled negotiators can’t talk an adjuster into a higher offer. If that happens to you, consult a lawyer. Your case might be worth far more than you think.

3. Consult with an attorney before accepting a settlement offer

Your best bet is to consult a lawyer before accepting a settlement offer. Even if you don’t think your injuries will cost you more money down the line, the truth is, you never know if you’re going to be one of the people who ends up with surprise injuries. 

Lawyers usually offer free consultations, so it won’t cost you anything to find out if you should pursue your injury claim in court, or try to negotiate a settlement with the insurance company.

4. If you’re low-income, a senior, or disabled, tell them you can’t pay

It’s hard to believe that anyone could wipe out any amount of medical debt just by telling a bill collector you can’t pay, but it happens all the time. In fact, people who have worked in billing departments often help their friends get out of medical debt because they know exactly what to say.

For example, say you’ve taken an expensive ride to the hospital in an ambulance and they’ve charged you full price. You’re on a payment plan paying $200 per month for the next 12 months. If you’re considered low-income and you’re receiving government assistance for food, cash, or even housing, use that to your advantage to negotiate your bill. You’d be surprised at how easy it can be to get small bills forgiven, and get larger bills greatly reduced.

5. Negotiate with doctors

Chances are, in the emergency room, you’ll be treated by doctors outside your insurance network. Even when the hospital takes your insurance, there’s no guarantee the doctors who treat you are in your network. Most ER doctors are independent contractors, and when they’re not in your network, you’re going to get a hefty bill for their services. 

Despite what most people think, you can negotiate with doctors. Your insurance company might negotiate for you as well. If not, file an appeal and ask your primary care physician for a letter affirming your treatment in the ER was medically necessary.

Medical bills are negotiable

Don’t let massive medical debt pile up and take you down. Medical bills are negotiable. Keep trying to negotiate your bills. Even after you’ve gotten a bill reduced, after six months of making payments, negotiate again. You might get a further reduction or elimination that can save you from having to file bankruptcy.