Before You Pay Your Hospital Bill, Read This

You may have already pleaded with your insurance company and battled with debt collectors.

But you still can’t get a break.

by Nilus Mattive of Daily Reckoning

Have you run up a huge hospital bill that you’re having difficulty paying?

The stress can be overwhelming, especially while you’re recovering from a complicated procedure and feeling like you’ve been hit by a truck. 

But you’re not alone…

The Consumer Financial Protection Bureau (CFPB) found that 43 million Americans have overdue medical debt on their credit reports.

You may have already pleaded with your insurance company and battled with debt collectors. But you still can’t get a break.

One resource you might consider is…

Hospital Financial Assistance

As part of the Affordable Care Act (Obamacare), all nonprofit hospitals must offer hospital financial assistance, also known as charity care. It’s optional at for-profit facilities.

The programs offer free or reduced-rates for certain patients. Yet the federal government doesn’t have any clear rules on how much assistance should be provided and who qualifies.

So that gives hospitals a lot of flexibility on what they offer and to whom.

Many base assistance on federal poverty guidelines (FPG). This is a measure of income and family size used by Washington to determine who is eligible for some federal programs. 

Others might have a sliding scale, which eliminates hospital debt for lower-income folks. Or there could simply be a standard amount of forgiveness.

Many hospitals post specifics about their financial assistance program on their website.

For instance, Jupiter Medical Center in Florida gives patients a 100% discount if their income is less than or equal to 200% of the FPG. If income is over 200% but not more than 400% of FPG, they’ll get an 80% discount.

The University of Pittsburgh Medical Center has a sliding scale. If patients have income below 251% of FPG, they’re eligible for 100% assistance. An income between 251% and 400% will get them partial debt forgiveness.

Here in California, USC hospitals grant a 100% discount for patients whose income is less than 200% of FPG. Those with family income between 201% and 350% will be eligible for a sliding scale discount.

Loyola University Medical Center is one of the more generous. The Chicago hospital has discounts for patients with family income as high as 600% of the FPG.

Other Criteria

Besides financial need, eligibility can depend on why you were in the hospital since some procedures, such as cosmetic and dental, might not be covered in your hospital’s program.

Also before requesting hospital financial assistance, you must have used all of any insurance benefits you were entitled to. That includes insurance from your employer, auto insurance, and workers comp.

Patients with sufficient assets to pay for care are ineligible for financial assistance.

How to Apply

Hospitals have application forms online that you can download, print, and submit. You’ll likely have to include proof of income with pay stubs and tax returns as well as a list of assets, liabilities, and family members.

You have up to 240 days after the initial billing to filing your application for assistance.

Call the facility’s billing office if you have questions on the application process.

And if You Don’t Qualify…

There are still steps you can take to get this monkey off your back.

The most important: don’t ignore it.

Because once a debt like that goes to collections, it can hurt your FICO credit report for up to seven years. And even land you in court.

So before your bill is sold to a collection agency, request an itemized statement from the hospital and ask that they put a hold on your account for 30 days. That gives you time to look for errors, such as double-billing and unexpected fees.

If you have medical insurance, they should have sent you or posted online an explanation of benefits (EOB) form. Compare it to the hospital’s itemized bill.

Is there something that you think the company should have paid but didn’t?

There could be a coding error, which may be why it was not paid…

For example, removing stitches from a gash on your arm, applying antiseptic cream, and covering it with a bandage at a walk-in clinic could have been coded as a much-more-expensive emergency room visit.

Or tests done by technicians could’ve been coded as being done by doctors.

Or is there a large unpaid amount on the EOB form that you have no idea where it came from?

Get on the phone with your insurer and request to speak with a representative.

You can also delve deeper by comparing your bill to your medical records to see if the services invoiced were actually performed.

Extreme? Perhaps. But doing this legwork could save you thousands.

One study found errors in 99% of bills analyzed for 2017. Double-billing for services and procedures were among the most common.

Finally, if you’re uninsured or haven’t hit your deductible yet, remember that almost everything is negotiable, even hospital bills.

Not sure how much to offer? The Healthcare Bluebook lists the fair price for procedures in your area.

You might also see if the hospital will let you repay the bill on a low-or no-interest installment plan.

And in case you end up in the hospital again, you may want to reapply for financial assistance. Your family circumstances might change, and the FPG adjusts annually.