Tessa Quinn
Hospitals offer financial assistance programs, sometimes called charity care, to provide free or discounted healthcare to patients who need help paying their medical bills. These programs are designed to assist patients who are uninsured or underinsured and may be offered by the hospital or the state. If your application for financial assistance is denied, you can appeal the hospital's decision by understanding the reason for the denial, drafting a letter explaining your financial circumstances, and providing supporting documents that prove your financial situation. You may also seek help from non-profit organizations or advocacy groups, or state-run financial assistance programs, depending on your location.
| Characteristics | Values |
|---|---|
| If your application is denied | Try to figure out why your application was denied and ask the hospital to reconsider the decision |
| What to do if your application is denied | Draft a letter explaining your financial circumstances and why you can't afford to pay the bill |
| What to include in the letter | Documents that prove your financial situation, such as recent taxes, paystubs, and bank statements |
| Where to send the letter | The hospital's billing or financial assistance office |
| How to obtain a financial assistance application form | Visit www.georgiaaccess.gov or ask for a copy of the hospital's financial assistance policy upfront |
| Who can apply for financial assistance | Uninsured, underinsured, and medically indigent patients with limited or inadequate resources to pay for healthcare services |
| Where to send the completed financial assistance application | Northside Hospital Business Office, 1001 Summit Blvd NE Suite 150 Atlanta, Georgia 30319 |
| What to do if your hospital bill is in collections | Notify debt collectors that you're seeking financial assistance and request them to pause collections while your application is pending |
| How to get help with your medical bills | Visit shiphelp.org to get free, personalized health insurance counseling |
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What You'll Learn
Ask for a copy of the hospital's financial assistance policy
If your hospital financial assistance application is denied, you can ask the hospital to reconsider its decision. Before applying, it is a good idea to ask for a copy of the hospital's financial assistance policy upfront. This will help you understand the eligibility requirements and how to apply. By law, the policy must be provided for free and must tell you how to apply for help. You can ask for the policy in your preferred language, in addition to English.
Financial assistance programs, sometimes called "charity care," provide free or discounted health care to people who need help paying their medical bills. Even if a hospital is for-profit or private, they may have a financial assistance policy. Some states have charity care laws that require hospitals to provide free or discounted care to patients who meet certain requirements, sometimes based on income. For example, patients with an annual household income less than or equal to 300% of the Federal Poverty Income Level may qualify to receive a full discount on care if they meet the hospital's financial assistance program guidelines.
To apply for financial assistance, you will need to fill out an application with information about your income and expenses. Ask your provider how long it takes to process your application, how to get answers to questions about the application, and what happens with your bill in the meantime. Notify any debt collectors trying to collect on the hospital bill that you are seeking financial assistance. You can ask them to pause collections while your application is pending.
If your application is denied, you can still ask the hospital to reconsider. Draft a letter explaining your financial circumstances and why you cannot afford to pay the bill. Send the letter to the hospital's billing or financial assistance office, along with documents that prove your financial situation, such as your most recent taxes, paystubs, and bank statements.
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Notify debt collectors and ask them to pause collections
If you are contacted by a debt collector regarding a medical bill, it is important to understand your rights and protections. Debt collectors must comply with federal laws, such as the Fair Debt Collection Practices Act and the Fair Credit Reporting Act, which prohibit them from engaging in harassing or abusive behaviour and impose specific requirements for reporting debts to consumer reporting companies. You have the right to ask a debt collector to verify that you owe the debt and to request an itemized bill, or "superbill," which outlines each medical billing procedure code, the amount paid by your insurance, and the amount you owe. This will help you identify any discrepancies or charges that cannot be legally collected, such as surprise bills prohibited by the No Surprises Act.
If you identify errors or discrepancies in the billing, you have the right to dispute the information. You can start by contacting the healthcare provider to request reductions or discuss payment arrangements. Nonprofit hospitals are required by law to offer financial assistance programs, and many other providers are willing to negotiate. Once you have reached an agreement with the healthcare provider, ensure you receive confirmation in writing and send a copy to the debt collector by certified mail.
If you are unable to resolve the issue with the healthcare provider, you can then contact the debt collector to discuss lowering the amount you owe. Patient advocates can assist you in understanding your bill, applying for financial assistance, and navigating your rights. You can find patient advocates through your healthcare provider's website or local agencies. It is important to avoid paying off medical charges with a credit card or loan, as interest and fees can increase your debt.
In the event that debt collectors engage in hostile or threatening behaviour, you can take legal action. Under the Fair Debt Collection Practices Act, you have the right to sue debt collectors if they use obscene language, impersonate an attorney, threaten to garnish wages or arrest, or engage in other harassing activities. If you choose to dispute the debt, do not make any payments until the lawsuit is settled, as you may be able to cover your medical bill with the financial reward if you win the case.
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Find out why your application was denied
If your hospital financial assistance application is denied, the first step is to find out why. Hospitals are required to provide a written Financial Assistance Policy (FAP) that includes eligibility criteria and whether the care is free or discounted. Check the hospital's website or ask for a copy of the policy to see if you meet the requirements. You should also look for a letter or call from the hospital explaining the denial and giving the reason for it.
Once you know the reason for the denial, you can take steps to appeal the decision. For example, if your income was miscalculated, you can provide additional documentation to support your application. If you have insurance, but it does not cover the full cost of your treatment, you may still be eligible for financial assistance from the hospital. In this case, you can provide details of your insurance coverage and any remaining balance or out-of-pocket expenses.
If you live in a state with charity care laws, such as California, Connecticut, Illinois, Maine, Maryland, Nevada, New Jersey, New York, Rhode Island, or Washington, you may be eligible for free or discounted care based on your income. Even if your hospital is for-profit or private, they may still have a financial assistance policy that can help you pay your medical bills. Ask the hospital for information about their policy and how to apply.
In some cases, you may be able to negotiate a payment plan or a discount on your bill. You can also seek help from non-profit organizations or advocacy groups that provide medical financial aid. Remember to notify debt collectors of your pending application for financial assistance and request that they pause collections during this time.
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Draft a letter explaining your financial circumstances
If your hospital financial assistance application is denied, you can draft a letter to appeal the decision. This letter should explain your financial circumstances and why you are unable to pay the bill. Here are some paragraphs you can use as a starting point for your letter:
Paragraph 1:
I am writing to appeal the decision regarding my financial assistance application. I recently received notification that my application for financial assistance from the hospital has been denied. I understand that there may be specific criteria for these applications to be approved, and I would like to provide additional context regarding my financial situation, which I hope will be considered during the reconsideration of my application.
Paragraph 2:
My annual household income falls below the Federal Poverty Income Level, and I am facing significant financial challenges. I have limited resources and struggle to meet my basic needs, including the cost of healthcare. My income is insufficient to cover the full cost of the medical care I require, and I worry that without financial assistance, I will be unable to access the healthcare I need.
Paragraph 3:
I am uninsured or underinsured, and my medical condition has resulted in substantial medical bills that I cannot afford to pay. I have attached relevant documentation, including my most recent tax returns, pay stubs, and bank statements, to support my claim. These documents demonstrate my financial hardship and the challenges I face in paying for my medical care.
Paragraph 4:
I would like to bring attention to my current financial obligations and expenses, which further contribute to my financial hardship. I have outstanding debts, and my monthly income is insufficient to cover my basic living expenses, let alone the unexpected and substantial medical costs I now face. I am concerned that without financial assistance, my financial situation will continue to deteriorate, and I will be unable to recover from this hardship.
Paragraph 5:
I respectfully request that the hospital reconsider my application for financial assistance and take into account the challenges I am facing. I understand the constraints and criteria that govern these decisions, but I believe that my circumstances demonstrate a genuine need for support. I am grateful for any help that can be provided, and I am hopeful that we can work together to find a solution that allows me to access the healthcare I need without facing financial ruin.
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Apply for state-run financial assistance programs or other financial assistance programs
If you are facing difficulties paying your hospital bills, there are several state-run financial assistance programs that you can apply for. These programs, sometimes referred to as "charity care," are designed to provide free or discounted healthcare services to individuals who need financial assistance for their medical expenses. Here are some options to consider:
State-Run Financial Assistance Programs
Many states have implemented their own financial assistance programs to help residents with medical debt. For example, states like California, Connecticut, Illinois, Maine, Maryland, Nevada, New Jersey, New York, Rhode Island, and Washington have laws in place that require all hospitals to provide free or discounted care to eligible residents. In contrast, Louisiana, Oregon, and Texas offer similar protections, but only for nonprofit or state-owned hospitals. Additionally, Colorado, Massachusetts, and South Carolina have state-run financial assistance programs that may be available to you. Each state will have its own eligibility criteria, so be sure to review the specific requirements for your state.
Hospital Financial Assistance Programs
Hospitals themselves often have financial assistance programs or policies in place to help patients struggling with medical debt. These programs are sometimes associated with foundations or nonprofits that work alongside the hospital to provide financial relief. For example, Northside Hospital offers financial assistance to uninsured, underinsured, and medically indigent patients who have limited resources. They provide full discounts on care for patients whose income is less than or equal to 300% of the Federal Poverty Income Level (FPL). Other hospitals may have similar programs, so it is worth contacting the hospital directly to inquire about their financial assistance options and how to apply.
State Pharmaceutical Assistance Programs (SPAPs)
If you are facing challenges in paying for prescription medications, State Pharmaceutical Assistance Programs (SPAPs) may be able to help. These programs are run by certain states and territories to assist individuals with limited financial resources in covering the costs of their medications. SPAPs typically focus on helping older adults but may also benefit other eligible individuals. Contact your state or local government to find out if SPAPs are available in your area and how to apply.
Consumer Assistance Programs
If you are experiencing issues with your health insurance or are facing unexpected medical bills, Consumer Assistance Programs can provide support. These programs, offered by many states, can help you understand your rights and protections against surprise medical bills. They may also offer resources for resolving billing disputes and submitting complaints if you believe your insurer or healthcare provider is not adhering to the rules. Reach out to your state agencies, such as the state attorney general or the state insurance department, to learn more about the specific Consumer Assistance Programs available to you.
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Frequently asked questions
If your hospital financial assistance application is denied, you can ask the hospital to reconsider the decision. You should first find out why your application was denied. You can do this by looking for a letter or email from the hospital. Then, draft a letter explaining your financial circumstances and why you cannot afford to pay the bill. Send this letter to the hospital’s billing or financial assistance office, along with documents that prove your financial situation, such as your tax returns, pay stubs, and bank statements.
Financial assistance programs, sometimes called "charity care," provide free or discounted health care to people who need help paying their medical bills. These programs may be provided by your medical care provider, your state, or non-profit organizations and advocacy groups.
First, ask your hospital for information about their financial assistance policy, including eligibility requirements and how to apply. You can also visit www.georgiaaccess.gov to learn more about financial assistance. To apply, fill out an application with information about your income and expenses. You can usually obtain a copy of the application form by visiting the hospital in person, or by requesting one by mail or online.
If you disagree with a coverage or payment decision made by Original Medicare, your Medicare Advantage or other Medicare health plan, or your Medicare drug plan, you can file an appeal. Before starting an appeal, you can ask your provider or supplier for any information that may strengthen your case. If you are in a Medicare Advantage plan, another health plan, or a drug plan, check your plan materials or contact your plan for details about your appeal rights.
Notify the debt collector that you are seeking financial assistance for the bill and request that they pause collections while your application is pending.
