Americans carry an estimated $195 billion in medical debt, but that doesn’t mean every bill is final. The total you see in the mail is often negotiable, and there are real ways to reduce what you owe.

If you have a planned procedure or scheduled medical services, you can negotiate your bill before receiving treatment. You can reach out to your medical provider for the estimated cost of your treatment. Present this to your insurance company to see how much your health plan will cover. Now that you know how much you’ll be paying out-of-pocket, speak with your hospital’s billing office to see your options.

People usually see the bill and numbers and think “I have to pay this quickly and I have to pay the exact amount”. That’s not the case.

Some reports estimate that as many as 80% of medical bills contain a billing error, and up to 25% of skilled nursing facilities’ claims will be overpaid because of errors made on a patient’s medical bill.

Duplicate charges are when you’re billed twice for the same service, while incorrect billing means you’re charged for something you never received. Upcoding happens when your condition is listed as more serious than it actually was, leading to higher charges. Unbundled charges occur when services that should be grouped together are billed separately, making your bill more expensive. Sometimes, the wrong billing codes are used altogether. If you didn’t get an itemized bill, ask for one - it breaks everything down and makes it much easier to spot errors.

See if you're eligible for the hospital's charity care program. To get started, you can search for your hospital's name plus "financial assistance." In most cases, this search should lead you to the hospital's policy.

45% of nonprofit hospital organizations send medical bills to patients who should qualify for charity care. These nonprofit organizations operate more than 1,651 hospitals across the country.

Non-profit hospitals are required to provide free or reduced care to patients within a certain income range, which varies from hospital to hospital. It's not always advertised, so reach out and ask about it. This can work at for-profit hospitals, too, but may be more challenging since it's not required.

If you don't qualify for financial assistance, ask the billing office for an itemized bill. This will show all the procedures you received and the associated code, called a Current Procedural Terminology code (CPT). Look over your bill (you may have to look up the CPT code) and ensure the charges accurately reflect your treatment. Medical bill errors are surprisingly common and it definitely pays to look yours over carefully. Were you charged for something that didn't happen? Are there any costs that seem way out of line? Call the billing office and let them know.

If you have some savings and you can afford to pay something up front, call the billing office and ask for a settlement amount, or what they'll accept if you pay the bill that day. Sometimes you can get 30 to 50% off.

If paying something up front isn't an option, you can ask the hospital to put you on a payment plan, which typically has lower interest rates than a credit card.

You may not get anywhere with the first couple of calls. But keep plugging away. You can write down the name of the person you're speaking to so you can refer to the call in the future if needed. And don't be afraid to ask friends and family for help making these phone calls. It's one way they can support you through a medical crisis.

If your doctor prescribes a medication that your insurance doesn’t cover or the price is just too high - don’t be afraid to ask for help. Many doctors have free samples on hand or coupons from the drug company that can lower the cost. It never hurts to ask, and it could save you a lot.

The same goes for doctors who don’t take your insurance. If you really want to keep seeing them, ask whether they offer a sliding scale. Some doctors are willing to charge less, especially if you’ll be a regular patient or if you’re dealing with a lower income. A quick conversation can sometimes make care much more affordable.