$5,995 for a leg compression sleeve? Here’s how to deal with an exorbitant medical bill in collections.

David Heydt had been hitting the tennis courts too hard and needed minor elbow surgery to loosen a tight tendon.

The 71-year-old Exton resident thought nothing of the compression sleeves to reduce the risk of blood clots during recovery that he was handed on his way out.

Three and a half years later, this past February, he received a collection notice for an unpaid bill for the fabric arm covering: $5,995.

He didn’t remember getting a bill, or even ever using the sleeves, which wrap around the calf and tighten like a blood pressure cuff when the attached battery pack is turned on.

“I found it last week in a closet,” Heydt said of the unopened box.

Heydt’s surprise shows how medical bills can sneak up long after you’ve recovered. And like most health problems, ignoring medical debt only makes it worse. Once in collections, medical debt can affect your credit rating, and some agencies may attempt to garnish your wages.

About 40% of Americans have unpaid medical bills, according to a 2022 survey by the Kaiser Family Foundation. A third of those with medical debt owe less than $1,000, but about half of Americans don’t have enough in savings to cover even $500 in unexpected costs.

Stumped about what to do, Heydt turned to The Inquirer. We looked into his options, now that the bill was in the hands of a debt collector.

Under federal law, debt collectors must send you a debt validation notice, with information about the amount you owe, the original creditor, and how to appeal.

You should also request debt verification, or proof of the debt in the form of a billing statement from the original creditor, said Courtney Jones, senior director of case management for the Patient Advocate Foundation in Virginia.

The collection agency can’t, under federal law, collect on a debt if they can’t verify it. File a complaint with the Consumer Financial Protection Bureau if the agency continues attempting to collect, despite failure to verify the debt.

Make your debt verification requests and any formal appeals of a debt in writing and keep copies of all correspondence. Letter templates with appropriate wording are available on the Consumer Financial Protection Bureau’s website.

When Heydt called the debt collector, Assured Financial LLC, to ask about the notice, the Arizona collection agency sent him a copy of the original bill from Philcare Medical Supplies. They also included a copy of the form that he’d signed in the doctor’s office agreeing to cover any costs not covered by insurance.

If you believe the bill is a mistake, appeal to the provider and your insurer.

Heydt has Medicare, which does not cover pneumatic compression devices, according to an explanation of benefits he received.

But he still didn’t think he should have to pay. When he had the procedure done at Premier Orthopaedics in Exton, administrative staff had told him they would not charge beyond what his Medicare insurance paid (though he never got that in writing).

Premier did not respond to a request for comment. Phone numbers listed online and in the debt collections paperwork for Philcare, the device company, were disconnected.

Heydt tried to appeal the Medicare denial earlier this year, but had long missed the 60-day window for such appeals. Aetna, which manages Heydt’s Medicare supplemental plan, declined to review his case because of how much time had passed since his procedure in September 2019.

If there’s no way out of the bill, it’s time to decide how you’ll minimize the financial damage, said Jared Walker, founder of Dollar For, a nonprofit that helps people challenge medical bills.

Ask if the collections agency reports medical debt to credit bureaus and if they sue to collect debts — not all do. Their answer may influence your next steps.

People who just want to get it over with (and have the cash to do so) may opt to pay in full. Those who can stomach the risk may choose to ignore the bill, especially if the agency does not report the credit bureaus.

The middle path is to try to negotiate a lower price. But haggler be warned:

“Buckle up. This can be brutal,” Walker said. Negotiating a bill may require several hours on the phone and multiple calls.

Gather evidence to support what you believe would be a reasonable charge that you’re willing to pay.

For instance, if your debt is for an out-of-network doctor or hospital, find out what your insurer would have paid an in-network provider, or what the Medicare rate would be. Medicare has a searchable price database for common medical procedures.

Heydt found that the pair of compression sleeves Philcare billed at almost $6,000 are available through online medical device companies for under $400. A box just like Heydt’s is going for $60 on eBay.

It also can help to tally your other monthly expenses and income as context for why you can’t afford to pay the bill in full, said Ruth Landé, vice president of hospital relations for RIP Medical Debt, a nonprofit that buys medical debt from collections agencies.

“Just lay out the facts,” she said. “We all have real, legitimate expenses.”

People often feel guilty or embarrassed to admit they can’t pay a bill and attempt to negotiate a lower price, Landé said. But debt collectors do it all day, and they know most people can’t afford the bills they’re sending.

Be firm but polite, and never apologetic. If you don’t feel confident, enlist a pushy friend or family member — they don’t have as much at stake and will approach the conversation differently.

Be clear that you can’t (or won’t) pay the full amount, but want to close the account.

Ask for their settlement amount, Walker said. All debt collectors have an amount below the full charge they’re willing to accept. Shoot for a 30-50% discount.

If you hit a dead end, call back another day.

You’ll get the biggest discount by offering to pay in cash, rather than setting up a payment plan.

“The best bartering tool you have is cash,” Walker said. “They’re not going to agree to lowering the payment unless you can close it out.”

Not much cash on hand? Walker recommends saving up for several months before making an offer, since medical debt doesn’t appear on credit reports until a year after first contact.

Don’t be tempted to resolve the problem by paying with a credit card, emptying your savings, or tapping into retirement accounts, said Landé.

“If you can’t afford to pay it, don’t pay it,” she said.

Heydt hasn’t decided yet what he’ll do. He doesn’t want the bill to affect his credit rating, but still feels the charge is unfair.

For now, he’s taking out his frustration on the tennis court — though his stomach sinks when he feels a twinge in his elbow on a particularly hard smack.