Help paying a hospital bill

Start with an itemized hospital bill

The first statement from a hospital is usually a summary. Call the billing office and ask for an itemized bill that lists every charge with its date, a description and its billing code. Check it against what you remember: the number of days you stayed, the tests you actually had, the medicines you were given. Duplicate charges, canceled tests and supplies billed twice do happen. Ask whether your insurance has fully processed the claim, since a balance billed before insurance finishes is not your final amount. If something looks wrong, put your question in writing and ask the hospital to pause collection on the account while it reviews the charges.

Find out whether the hospital is a nonprofit

Many hospitals are nonprofit organizations, tax-exempt under section 501(c)(3) of the federal tax code. To keep that status, section 501(r) adds four requirements: a regular community health needs assessment, a written financial assistance policy, limits on what eligible patients are charged, and rules for billing and collection. The last three can make a big difference to your bill. Ask the billing office directly whether the hospital is a nonprofit, or check the hospital's website, which often says so. For-profit hospitals do not have to follow section 501(r), but ask them anyway whether they have a discount or charity care program. Public hospitals run by a county or city may have their own programs too.

Apply for hospital financial assistance

Under section 501(r), a nonprofit hospital's financial assistance policy must spell out who qualifies for free or discounted care, how the discount is figured and how to apply. The hospital must post the policy, the application and a plain language summary on its website for anyone to view and print for free, and offer free paper copies, including in the emergency room and admissions areas. Patients who qualify cannot be charged more than the amounts generally billed to insured patients for emergency or other medically necessary care. Eligibility levels differ from one hospital to the next, so read the policy instead of guessing. Fill in every part of the application and keep copies of everything you send.

Know the collection timeline

The same Internal Revenue Service (IRS) rules slow down aggressive collection. A nonprofit hospital must make reasonable efforts to find out whether you qualify for help before taking what the rules call extraordinary collection actions, such as placing a lien on your property, seizing a bank account or garnishing wages. That includes waiting at least 120 days after the first bill sent after you leave the hospital, and giving written notice at least 30 days before such actions begin. You can apply for assistance during an application period that runs 240 days from that first bill. If you send a complete application during that window, the hospital must suspend those collection actions until it decides.

If you were uninsured or paid on your own

If you had no insurance, or chose not to use it, the No Surprises Act gives you the right to a good faith estimate for care you schedule in advance or whenever you ask for one. If the final bill from a provider or facility comes in at least $400 above that estimate, you may be able to dispute it through a federal process. The bill must be dated within the last 120 calendar days, and the dispute has a $25 fee that comes off what you owe if you win. Without an estimate, you can still ask the hospital for its self-pay discount and whether it offers a lower price if you pay part of the bill quickly.

Negotiate the balance and set terms

Once you know the true balance, call and ask what discount the hospital offers if you pay part of it in one lump sum. Ask for a payment plan with a monthly amount you can keep up with, ask whether the plan charges interest, and get the terms in writing. Think twice before putting a hospital bill on a credit card or a medical financing card, which can turn a negotiable balance into high-interest debt. If the account has already gone to a collection agency, ask the hospital whether it can be recalled while your assistance application is reviewed. Keep a log of every call with the date, the name of the person and what they said.

Where Settlemont fits with a hospital balance

Once the balance is final and correct, a hospital bill can go on Settlemont in the Medical category. Medical submissions get stricter privacy and require a separate health-data consent, and you never list a diagnosis, a treatment or a patient account number. The form asks for first name, email, state, category, amount and due date. Staff then verify the hospital, you as the bill owner and the current balance, and every submission goes through duplicate and fraud checks. Supporters choose a verified bill and an amount, and support goes directly to the hospital, never to you as cash. They pay a 7% card or 5% bank service fee on top. Keep your financial assistance application moving while the bill is listed.

Sources

• IRS: Requirements for 501(c)(3) Hospitals Under the Affordable Care Act, Section 501(r)
• IRS: Financial Assistance Policy and Emergency Medical Care Policy, Section 501(r)(4)
• IRS: Billing and Collections, Section 501(r)(6)
• Centers for Medicare and Medicaid Services: Dispute a Bill

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