She was hit with a huge hospital bill she wasn’t expecting. Here’s how you can avoid the same fate.

When Lori Handerhan almost died in the emergency room due to a heart issue, she got excellent treatment from South Shore Hospital. But then she was hit with a bill of more than $32,000 from the hospital.Suzanne Kreiter/Globe Staff

On Sept. 9, Lori Handerhan was rushed from her cardiologist’s office in Weymouth to South Shore Hospital’s emergency room next door with a heart rate so low doctors feared she would die.

Handerhan, 62, was treated for a condition known as “complete heart block,” when the electrical impulses that control the beating of the heart are disrupted.

During five days at South Shore Hospital, Handerhan says she received excellent care, including surgery to implant a pacemaker to regulate her heart.

But in the months that followed, as she tried to get her life back on track, Handerhan faced another frightening experience: How to pay tens of thousands of dollars in medical bills on an annual family income of about $100,000.

Handerhan put long hours into trying to navigate the notoriously complex worlds of private health care insurance, hospital billing, and government medical assistance programs.

Stressed and bewildered by what she found, she contacted me for help late last month.

Handerhan said South Shore Hospital initially seemed sympathetic to her financial plight. It slashed almost $10,000 off her $32,193 bill.

But that left a balance of $22,811. And on Jan. 10, the hospital warned Handerhan that if her debt remained unpaid, it could be turned over to a collection agency.

“I really can’t afford to pay this bill,” she wrote to me. “Is there anything else I can do?”

Ultimately, South Shore Hospital agreed to wipe out the balance of $22,811. “Please be advised that your balance is zero,” it wrote in a Feb. 8 letter to Handerhan, after inquiries from the Globe.

“It’s great news,” Handerhan told me after receiving the letter. “I’m thrilled. Now I can go on with my life.”

But there are lessons to be learned from her experience:

South Shore Hospital in Weymouth in Aug. 26, 2020.Pat Greenhouse/Globe Staff

Q. Why didn’t Handerhan’s insurance pay for her care?

A. Last year, Handerhan purchased a plan online for her and her husband from Sovereign Nations Insurance, which was founded by a group of Indian tribes and is open to non-Indians. Handerhan said she was shocked when South Shore Hospital later said her plan did not cover her stay in the hospital. Sovereign Nations had covered her prior doctors appointments, and she had assumed she was covered for hospitalizations, too, she said.

But Sovereign Nations rejected her claim for coverage at the hospital, writing that she had “no plan benefits for inpatient hospital services.”

Q. Didn’t Sovereign Nations disclose its limitations on coverage?

A. I found the plan documents Handerhan shared with me to be confusing and contradictory. Based on what I read, Sovereign provided Handerhan with little or no coverage for hospitalizations.

No consumer should buy health care insurance that lacks coverage for hospitalization. It’s fundamental. Double check to make sure you understand what you are getting.

Two good resources are the Health Connector, the state’s well-regarded online insurance marketplace, and Health Care for All, a patient advocacy organization. People shopping for insurance should begin with the Health Connector. But make sure you are on the right website.

Q. The “right” website?

A. Yes, beware of websites that look like government-sponsored insurance marketplaces, but aren’t, according to the state Division of Insurance. (Look for websites that end in “.org,” not “.com,” for one thing.) Look-alike websites try to cash in on sales commissions by peddling stripped down, inexpensive plans that look attractive but, in the fine print, disclose limitations (like little or no hospital coverage).

Q. How did Handerhan find Sovereign Nations?

A. When we first talked, she told me she found Sovereign Nations on the Health Connector. But actually, Sovereign Nations is not listed there. Handerhan now believes she was duped into thinking she was on the Health Connector site but actually was on a look-alike site. It gave her a false sense of security when she found Sovereign Nations on that site.

Q. Is Sovereign Nations known to the state Division of Insurance?

A. The Division of Insurance names half a dozen insurance organizations for which it has received consumer complaints or inquiries, including Sovereign Nations. It says Sovereign Nations is not licensed in Massachusetts and does not comply with the Affordable Care Act.

Sovereign Nations declined to comment.

Lori Handerhan put long hours into trying to navigate the notoriously complex worlds of private health care insurance, hospital billing, and government medical assistance programs.Suzanne Kreiter/Globe Staff

Q. Isn’t there a new law protecting people like Handerhan who get emergency services?

A. Yes, the federal No Surprises Act, which went into effect last year, does offer certain protections to people who get treatment in emergency rooms. The bipartisan law was passed in response to bitter complaints from consumers who, in an emergency, went to the closest ER. The problem was that consumers sometimes got billed thousands of dollars because the doctors who treated them were not in their plan’s network, even though they had good coverage from solid insurers.

The new law mandates equal insurance coverage in all ERs and licensed urgent care centers by eliminating the distinction between “in” and “out” of network. You pay the copay or deductible required of your in-network plan, even at an out-of-network facility.

Problem is, most of Handerhan’s bill was for five days in the hospital, which likely is not covered by the law because she had subpar insurance.

Q. Why did Handerhan stay five days?

A. Handerhan’s bill was so large in part because her stay was so long. By the time she was admitted it was Friday evening. Her surgery was scheduled for Monday. After surgery, doctors discovered fluid on her sternum and kept her for another two days.

Q. Did South Shore Hospital know she was essentially uninsured?

A. Yes, she provided her insurance information. Hospitals can not deny emergency treatment to someone without insurance under the federal Emergency Medical Treatment and Labor Act.

Q. What steps did the hospital take on her behalf?

A. It filed an application for coverage under MassHealth, the state program that provides health care coverage for people who have low income. But Handerhan’s household income is too high to qualify.

The hospital also filed for funding under the state medical hardship program, which is part of the “health safety net.” Medical hardship assistance is approved when a medical debt exceeds a certain percentage of income. According to the formula, Handerhan qualified for only a negligible amount.

South Shore Hospital, like other non-profit facilities, is required under federal law to provide free or discounted care, based on income, irrespective of insurance. Hospitals are also required to have a financial assistance policy, such as this one, posted on South Shore Hospital’s website.