Charity Care - Financial Assistance for Hospital Bills

1. What is CHARITY CARE?

Charity Care is financial assistance for medical services. If you cannot afford to pay your hospital bill, you may be eligible to have part or all of the bill forgiven as Charity Care. Some medical groups (doctors) also do this.

Charity Care policies vary greatly from hospital to hospital and from medical group to medical group. Many hospital policies forgive the entire hospital debt for people living below 150% of the federal poverty level (FPL). Others forgive the entire hospital debt for people living below 200% of FPL.

In 2013, 150% FPL for a family of four was $2,944 per month. 200% was $3,925.

Even if you don't qualify for completely free care, you may at least get a partial discount.

NOTE: If you have hospital bills for services that should have been covered by the Oregon Health Plan (Medicaid), the hospital and doctor may not be able to collect from you. Please call the Public Benefits Hotline for more information: 1-800-520-5292.

2. Do i qualify for charity care?

Again, Charity Care policies vary greatly. You are more likely to be eligible if both of the items below apply to you:

• Your household has low income and few financial resources, especially compared to your household's necessary expenses.

• The bills that you owe are for services that were medically necessary. Elective surgery, such as cosmetic surgery, probably won't be covered.

In addition, some hospitals and medical groups will only allow Charity Care if you were uninsured when you received the treatment. Similarly, some hospitals and medical groups may deny Charity Care if you were eligible for health insurance, but refused to apply for it.

3. What else do I need to know?

One thing to keep in mind is that a hospital's Charity Care policy may not apply to the medical groups that practice within the hospital. Hospitals contract with medical groups to provide services inside the hospital. Medical groups are made up of doctors, nurse practitioners and other medical providers, including some you may never meet. The hospital's financial assistance policy does not always apply to the medical groups - it just depends upon the hospital and medical group. Some groups have their own separate policy.

Another thing to keep in mind is that even if you qualify for full Charity Care for an old hospital bill, that doesn't mean the hospital or doctor has to provide future treatment for free.

4. How do I apply for charity care?

To apply for financial assistance, contact the billing department of your hospital and ask to apply for financial assistance. Also ask if medical groups in the hospital follow the same policy. If they don't, call the medical group to see if they have their own policy that you can apply for. Even if the hospital bills are very old, you may still be able to get financial assistance based on your current financial situation. You should act as soon as possible - even if your bills have been sent to collections.

5. What do I do if I'm denied charity care (or I believe I should get a larger discount)?

If you are denied Charity Care, you should ask the hospital or medical group to reconsider the denial. This may not be a formal process, but most hospitals allow a chance to appeal. Be sure and find out the exact reason why your application was denied. There are two basic reasons why your request for financial assistance may be denied:

• You didn't provide all the information requested. This one is easy - just ask for time to give them the rest of the information. If it's impossible to get the information requested, explain why.
• The hospital or medical group decided that you don't meet their guidelines. Find out exactly what the problem is and gather information to prove that you do meet their guidelines. Even if you don't meet the guidelines, you may be able to convince the hospital or medical group to allow financial assistance if your case is especially sympathetic.

Oregon Health Action Connect may be able to provide you with more guidance on Charity Care plans. Call 211 to reach Health Connect

6. I appealed, but they still denied me. Now what?

At this point, you may want to try to work out a reasonable payment plan with the hospital or medical group. If your account has already gone to collections, the collection agency may also be willing to accept a payment plan. If you have extremely low income, or if your only income is through public benefits, you may be "judgment proof."

Keep in mind that if your financial situation gets more difficult later, you may be able to reapply for Charity Care.

For more information, call the Public Benefits Hotline (1-800-520-5292) or your local Legal Aid Services office. Click here for a directory of legal aid programs.

05/2013