Hospital Financial Assistance: Ask Before You Agree to Payments

What hospital financial assistance means

A financial assistance policy (a hospital program that lowers or forgives bills based on income, sometimes called charity care) can reduce or remove qualifying hospital charges. These programs may help you whether you are uninsured or insured, and they can matter most when you are insured but still facing high out-of-pocket costs (the share of a bill that your insurance does not cover).

A nonprofit hospital (a hospital that is exempt from certain taxes and is expected to serve its community) is required by federal tax rules to have a financial assistance policy. IRS rules also require the hospital organization to make reasonable efforts to determine whether you qualify before it takes certain aggressive collection steps.

Ask for the policy, not just a payment plan

When you call, a billing representative may offer monthly payments first. Before you discuss any payment amount, ask for the financial assistance policy and the application form, because a payment plan does not lower what you owe the way financial assistance can.

You can use these questions on the call:

• Do you have a financial assistance or charity care policy?
• Can you send me the written summary and the application?

What income, household, and insurance documents are required?

The hospital decides what proof of income, household size, and insurance status it needs, so ask the representative to spell out the requirements for you. While you have them on the phone, you can also confirm how the account will be handled during the review.

Ask the representative these questions:

• Can this account be placed on hold during the application review?
• Will collection activity pause while the application is pending?
• Are discounts available for insured patients with high out-of-pocket costs?
• Is there a deadline to apply for assistance on this bill?

Documents to gather before applying

Before you apply, gather the documents the hospital is likely to ask for:

• The hospital bill and its account number.
• The explanation of benefits (the insurer's summary of what it paid and what you owe), if insurance was used.
• The proof of income that the hospital requests.
• The household size information that the hospital requests.
• Proof of your current insurance status.
• Recent denial or approval notices for public benefits, if they are relevant to the application.
• Any written notice from the hospital about collections or account holds.

Ask for an account hold in writing

A financial assistance application can take time to review, so ask whether the hospital can place the account on hold (pause billing and collection on it) while the review is under way, and ask the representative to send you written confirmation of that hold.

If the hospital will not send a written hold, document the call yourself. Write down the date, the time, the representative's name, the phone number you called, and the exact instruction you were given.

Check the bill while the application is pending

Reviewing the bill and applying for financial assistance can happen at the same time. Even while your application is pending, the bill may still contain duplicate charges, insurance that was processed incorrectly, adjustments that are missing, or charges that belong under an appeal (a formal request to have a charge corrected or reconsidered).

Compare the hospital bill against the explanation of benefits. If the hospital has not sent you an itemized bill (a line-by-line list of every charge), ask for one.

A payment plan can wait until the bill has been reviewed. It may help once the final amount is correct and you have reviewed your assistance options, but the order matters: first review the bill, the insurance processing, any surprise billing issues (charges from an out-of-network provider that you did not choose), and financial assistance, and only then compare payment terms.

What to put in a written request

When you put your request to the hospital in writing, include each of these:

• The patient name and the account number.
• The date of service.
• A request for the financial assistance policy and application.
• A request for an account hold during the review.
• A request for written confirmation of the hold.
• A request for an itemized bill, if one has not been provided.