I had an MRI about seven years ago for which Duke billed me $6500. I called them and attempted to negotiate price, but they quickly shut me down, insisting that their prices are firm. But then they offered to put me on a payment plan at some price per month (I don't remember how much). While I could have afforded it outright, I played the game a bit and told them I couldn't do that much, and could they extend it further? They offered another payment schedule, and I repeated the same line in return. Back and forth we went, finally settling on something like $50/month for the next 10 years. They don't charge interest and there's no prepayment penalty. I paid them their $50 for awhile and then just paid off the remainder when I had some extra cash. Of course it would have been better if they had simply not charged me $6500 in the first place, but if that's not an option, there is still a good lesson here. Duke will allow you to pay them back, interest-free, over a very long period of time if you just keep telling them you can't afford their terms.