But court records show that communication can break down, leaving some patients uncertain about when they may be held responsible for paying.
Take the case of Renee D. Alisea, a single mother and hairdresser. She faces a lawsuit by Franklin Square Hospital over a $10,800 bill. Like many patients taken to court, she had insurance, but it didn't pay for surgery.
Alisea had a hysterectomy in August 2006 because her sister was dying from ovarian cancer and a genetic test suggested that she could suffer the same fate without surgery.
In court pleadings, Alisea maintained that her surgeon - who had also treated her sister - promised her that his services would be free because of her "poverty" and said he had "made arrangements" for the hospital to waive its charges. Alisea, who had previously received state assistance to pay her son's medical bills, contended that she would have declined the surgery if she had thought she would receive a hospital bill.
Hospital officials would not comment on the case, which is set for trial in Baltimore County Circuit Court in March.
"My battle is I am paying $2,500 for a lawyer fee I cannot afford, but it's either that or pay an $11,000 bill. I have been at my job for 17 years. I work hard. If I never had the surgery, I never would have been sued, but I was looking at my sister lying there dying of cancer," said Alisea, 43, who lives in Essex.
Linda M. Zerance, a Baltimore homemaker, racked up a half-million-dollar hospital bill after suffering injuries in a car accident in October 2006. Insurance covered all but $154,267. But only after the University of Maryland Medical System sued her in Baltimore City Circuit Court in June 2007 did it qualify her for charity care to cover all but $26,000. She paid that amount from an auto insurance settlement.
Zerance said the lawsuit might have been avoided had she been told about charity care earlier.
"I didn't hear about financial aid until the hospital said they would take a plea bargain," said Zerance, who is still recuperating from her injuries.
Officials at several hospitals said they routinely sue patients a year or more after writing off their bills and building those losses into their rate requests. They said that money recovered from lawsuits is deducted from requests in subsequent years but that aggressive collections get them paid faster.
