What to Know About Hospital Financial Assistance (Charity) and State Medicaid Policies

Nonprofit hospitals are required to offer these programs, but they vary by facility and state.

What’s a Hospital Financial Assistance Policy?

Financial assistance policies help provide free or discounted medical services to patients who meet certain eligibility standards and are unable to pay for their medical treatments. They were created under the Affordable Care Act to address medical debt and increase transparency. Specifically, these regulations apply to nonprofit hospitals and are overseen by the Internal Revenue Service, or IRS.  The programs are intended to introduce them to consumers who are uninsured or underinsured.

How Do I Know if I Qualify for a Financial Assistance Policy?

First, you’ll need to verify that the facility you visited offers financial assistance or charity care. If you received treatment at a nonprofit hospital, then federal law requires there to be a policy in place. If you received treatment at a for-profit medical center, it can’t hurt to ask if there’s financial assistance available, but the hospital is not federally required to offer it.

Next, you’ll want to determine whether your income and family size qualify you for financial assistance. These eligibility cutoffs vary depending on the hospital. For example, the University of Pittsburgh Medical Center uses a sliding scale to determine assistance amount. If the patient earns between 400% and 251% of the federal poverty guidelines, he or she will earn partial financial assistance. If the patient earns 250% or less than the federal poverty guidelines, that patient is eligible for 100% financial assistance and for UPMC service fees to be waived. UPMC also offers hardship assistance for qualified families where medical liability exceeds 15% of family income.

Finally, you’ll need to have undergone a procedure that qualifies for financial assistance. You may find that cosmetic procedures, dental care and other treatments are not covered.

How Do I Apply for a Financial Assistance Policy?

If you have questions about the financial assistance plan, where to find the financial assistance application and how to determine whether you apply, call the facility’s billing office. That should get you started in the right direction. But sometimes, patients don’t hear about the program or are accepting emergency care and can’t plan for it until after medical services are received. You’ll generally need to start the application process within 240 days of receiving your first bill.

The application may require tallying up income, sharing the names of your family members and detailing other assets. Generally, if you have insurance, you’ll need to have exhausted all of those benefits, including employer-sponsored health insurance, automobile insurance and workers’ compensation, before tapping charity care.

What Do I Do if I’ve Been Denied Financial Assistance?

If you don’t qualify, don’t despair. Hospital representatives say patients may be able to repay their bills on a low- or no-interest installment plan or take out a short-term loan with a partner bank.

You may also want to reapply in future years if you take on new medical bills. After all, your family circumstances and the federal poverty guidelines change from year to year, so a denial in the past may not exclude you from having an application accepted in the future.

In Conclusion

Many consumers may qualify for Financial Assistance but are unaware it is available.  Make sure you ask about it!

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