Can I Get Charity Care Benefits To Pay For My Hospital Bill?
Authored By: Northwest Justice Project - CLEAR Intake Line
Federal and state laws require hospitals to provide you certain types of medical care for free or at a reduced cost if you cannot afford to pay for the medical treatment. Charity Care covers “medically necessary” treatment, including inpatient hospital stays and emergency room visits. #5909EN
- What is Charity Care?
- How will I know about the hospital's Charity Care program?
- Am I eligible for Charity Care?
- I have medical insurance. Should I still apply for Charity Care?
- When can I apply for Charity Care?
- I did not apply for Charity Care while I was in the hospital or after my release. I just got a letter from a collection agency about the hospital bill. Can I still apply?
- I did not apply for Charity Care. I am being sued for the hospital bill. What should I do?
- Where can I get a Charity Care application form?
- How does the hospital decide if I am eligible for Charity Care?
- How long will the hospital take to decide my Charity Care application?
- I submitted a Charity Care application. What happens next?
- I already paid my hospital bills. Should I apply for Charity Care now anyway?
- What if the hospital has gotten a judgment against me for hospital services Charity Care should have covered?
Federal and state laws require hospitals to provide you certain types of care for free or at a lower cost if you cannot afford to pay for the medical treatment. Charity Care covers “medically necessary” treatment. This includes inpatient hospital stays and emergency room visits.
Some hospitals have a different name for their Charity Care programs, such as Bridge Assistance or Financial Assistance.
*Charity Care may not cover services by medical providers who are not considered part of the hospital’s medical staff or visits to a hospital’s outpatient clinics. Examples: It does not cover radiologists or anesthesiologists who work in the emergency room but are not employed by the hospital.
Every hospital that offers Charity Care must
Post a notice about Charity Care in the emergency room, admissions area, and the financial service or billing areas that are open to patients
Provide a patient with Charity Care information at intake or discharge
Post a plain language summary of the hospital’s current Charity Care policy and the application form on the hospital’s website
Provide the summary and application in all languages spoken by more than 10% of the population served by the hospital
Provide a patient with Charity Care information in every billing statement
Provide all billing statements and written communications in both English and the second most spoken language in the hospital’s service area
Not all hospitals provide notice of charity care even though the law requires them to. Sometimes, notice is provided but you do not see it. When you are very sick, you may not be focused on notices or forms you are signing.
*Always ask if there is Charity Care or financial assistance and apply.
If you have Medicaid, Medicare, or other medical insurance, you must use those benefits first.
How much Charity Care you may get depends on your income and household size. If your household income is low enough (below 100% of the Federal Poverty Level), the hospital must cover (write off) your eligible hospital bill.
If your household income is more than 100% of the Federal Poverty Level, you may get some of your hospital bill reduced. But the hospital has a right to get information about your assets.
Each hospital has its own Charity Care policy. The amount of Charity Care provided to patients with household income above 100% of the Federal Poverty Level varies. To see a hospital’s Charity Care policy, go to http://www.doh.wa.gov/DataandStatisticalReports/HealthcareinWashington/HospitalandPatientData/HospitalPolicies, or call the hospital for a copy of their Charity Care policy.
*Even if you are not sure you are eligible for Charity Care, you should apply. Hospitals can give Charity Care discounts of up to 400% of the federal poverty level.
*All patients, if otherwise eligible, can get Charity Care, regardless of citizenship or alien status.
Yes. Your insurance might have high deductibles. It might only cover part of a hospital bill. If you have a low income, Charity Care may cover these deductibles or co-pays.
You can apply while you are in the hospital OR after your release. You should apply as soon as possible, before the hospital sends the bill to collections or you are sued for the hospital bill.
*Always keep a copy of your application and all documents you give the hospital.
*Get proof of the date you submitted your application and documents to the hospital.
I did not apply for Charity Care while I was in the hospital or after my release. I just got a letter from a collection agency about the hospital bill. Can I still apply?
Yes. If you get a letter from a collection agency about the hospital bill, you should:
Apply for Charity Care immediately, if you have not already.
Send the collection agency a letter demanding it stop all collection activity while the hospital is considering your Charity Care application. Keep a copy. See SAMPLE LETTER #1.
If you are sued for the hospital bill and are served with (handed) court papers, you should:
Apply for Charity Care immediately.
Respond in writing to the lawsuit. Read How to Answer a Lawsuit for Debt Collection. It explains how you can state in the Affirmative Defense section of your Answer that you are eligible for Charity Care. We also have an online interview that generates forms and instructions for you at washingtonlawhelp.org.
Send the plaintiff’s attorney a letter telling them to put the lawsuit on hold while the hospital is considering your Charity Care application. See SAMPLE LETTER #2.
Talk to an attorney who is knowledgeable about Charity Care as soon as possible.
If you are not given an application form when you are admitted to or discharged from the hospital, you can get one from the hospital’s billing office. You can ask the hospital to mail you the form or get it on the hospital’s website.
The hospital first makes an initial determination of eligibility based on information you verbally give it.
After the hospital makes an initial determination of eligibility, you must provide the hospital proof of your income, and your assets, depending on your household’s income. Examples of proof of income:
Income tax returns from the past year
W-2 statements from your employer
Social Security or Unemployment income statements
DSHS documents, including medical coupons and/or approval for cash benefits
You must provide these documents in the time period stated in the hospital’s letter. If you need help or more time with the application because of a language barrier, disability, or any other hardship, call the hospital. Ask for more time or help. If you provide all the information requested and the hospital needs more, they must ask you in writing for more documentation. If you do not provide all documentation by the deadline, the hospital may deny your application.
Once the hospital has gotten from you the documentation it asked for, it must make a final determination of your eligibility within 14 days.
If the hospital approves your Charity Care application, it must send you a letter explaining how much of the bill is covered and how much, if any, you still owe.
If the hospital denies your Charity Care application, it must send you a letter of denial. It says how you can appeal the denial. It must say why they denied you Charity Care. It also must state that you only have 30 days to appeal.
Yes. If you made payments and then the hospital awards you Charity Care, you can get your money back.
What if the hospital has gotten a judgment against me for hospital services Charity Care should have covered?
In a few cases, you may be able to get the judgment vacated (canceled). If neither you nor any member of your household was handed the court papers (the Summons and Complaint), talk with a lawyer as soon as possible.
This publication provides general information concerning your rights and responsibilities. It is not intended as a substitute for specific legal advice.
This information is current as of January 2019.
© 2019 Northwest Justice Project — 1-888-201-1014.
(Permission for copying and distribution granted to the Alliance for Equal Justice and to individuals for non-commercial use only.)