Also be aware that even if you seem not to qualify for financial assistance based on a hospital’s policy, you can apply and explain your circumstances. Because of the high cost of care in the U.S., even many middle-income people qualify. And many hospitals give their finance departments leeway to adjust bills. Some patients discover that if they offer to pay cash on the spot, the bill can be reduced dramatically.

All nonprofit hospitals have a legal obligation to help patients: They pay no tax in exchange for providing “community benefit.” Make a case for yourself, and ask for a supervisor if you get an initial “no.”

For elective procedures, patients can follow the Fierros’ example, becoming savvy health care shoppers. Recently, Claudia needed an endoscopy to evaluate an ulcer. The family has been calling different facilities and discovered a $500 difference in the cost of an endoscopy. They will soon drive to a medical center in Central Valley, California, two hours from home, for the procedure.

The Fierros didn’t even consider going back to their local hospital. “I don’t want to say ‘hello’ and receive a $3,000 bill,” joked Jesús Sr.

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(Stephanie O’Neill contributed the audio portrait with this story.)

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Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!