SIOUX FALLS, S.D. — You go to the hospital, then the bills pour in. Not just from the hospital, but from several other companies.

Wait a minute, you ask: Didn't I just visit the hospital once? Why am I getting so many different bills?

We here at Forum News Service have heard this question over and over. So we reached out to Sioux Falls-based Sanford Health for answers on how billing works, how you can know which bill to pay and with whom you should speak if you need help.

The below is an edited version of our conversation with Martha Leclerc, Sanford Health vice president for corporate contracting, a long-time pro in the inner workings of medical billing and payments.

Why do I get so many medical bills from one hospital visit?

Answer: When you visit the hospital, you’re frequently dealing with more than one company. So, you’ll get more than one bill.

For example, you might go to the emergency room in a Sanford Health hospital. But the doctor that treats you may be independent, or may work for another company, say, a physicians group. That means more than one bill: one from your doctor, one from the hospital.

The same could be true for other services you use in the hospital. Just because you’re getting treated in a Sanford hospital doesn’t mean you’re only dealing with Sanford-employed health care professionals.

Why do I get so many bills for the same thing?

Answer: Unlike buying something in a store, where you’ll get one bill of sale, the medical bill process is a lot more complicated so there are a lot more mailings.

If you’re like many patients, you’ll get a lot of paperwork that isn’t actually a bill. Many of the letters you’ll get in the mail are actually just informational statements your doctor and your insurance company are required to send you.

You’ll get paperwork from your insurance company explaining what it’ll pay (an Explanation of Benefits, which is not a bill at all), and separate itemized bills from your doctor, hospital etc. This adds up to a lot of mailings, most of which is the bottom-line, actual bill you’re expected to pay.

You’ll get even more paperwork, and all this can take more time, the more complex and length your hospital visit.

Still confused? Every health care system has someone you can call to help you navigate your bills. At Sanford, those people can be reached by calling 877-629-2999.

So when should I pay my medical bill?

Answer: You likely don’t want to pay the first bill you see, Leclerc says. It was likely generated before your insurance decided how much of your bill it will pay.

Instead, wait until you get a bill that shows 1) how much your insurance has covered your bill, and 2) how much is left that you have to pay. That's the bill you pay.

What should I do if I can’t pay my medical bill?

Answer: If you can't pay your bill, you have options. All health care systems have people you can call to walk you through exactly what those options are (For Sanford, again, that number: 877-629-2999).

At Sanford, your options will include setting up a no-interest payment plan. If you genuinely can’t afford to pay, Sanford may eliminate some or all of your charges, and cover them under the health system’s charity care program.

Take care, though: Not every health care provider that sends you a bill will have as many payment options available to you, or have charity care available to help if you can’t pay.

What happens if I don’t pay my medical bill?

Answer: Sanford does eventually send some bills to collections, if they can’t get in touch with the patient or if no payment ever gets worked out. But Sanford does not send medical bills to credit reporting agencies, which means your unpaid medical bills will not affect your credit rating.

Only in very rare cases will Sanford sue a patient over a medical bill, Leclerc says, and only after Sanford is convinced the patient has the ability to pay and is choosing not to do so.

While many other nonprofit health care systems follow similar procedures, not all do. Nor do all private health care providers.

Have a health care industry-related question? If you have a question about how health care works or doesn't, get in touch and we'll see what we can find out, for possible use in a future article. (No medical questions please, we're not doctors.) Send your question to Jeremy Fugleberg via email at jfugleberg@forumcomm.com.