How well do hospitals help patients regarding the bill?

Earlier today, Health Access California participated in the release of a new hospital survey by Community Catalyst and The Access Project, showing that many hospitals are still not telling patients about financial assistance programs for which they may be eligible. This release follows the enactment of new requirements on nonprofit hospitals, as part of national health reform, to inform patients of financial assistance programs for which they may be eligible.

Yet stronger government oversight is needed to ensure that non-profit hospitals inform patients about patient financial assistance programs for which they may be eligible.

The new report, “Best Kept Secrets,” is based on a national survey of non-profit hospitals conducted by The Access Project in the summer of 2009. The survey found that while most hospitals mentioned the existence of financial assistance programs on either their websites or over the telephone, only about a quarter provided information regarding eligibility for financial assistance. Fewer than half provided a financial assistance application form. A small percentage provided information on their websites that listed the discounts available to people at different income levels.

These findings are comparable to Health Access’ experience with California’s groundbreaking Hospital Fair Pricing Act of 2006, which requires hospitals to provide significant discounts to eligible patients and to tell patients how to apply for the discount.

Nearly three years after enactment of the Fair Pricing Act, we here at Health Access still hear regularly from California consumers through our consumer assistance site,, that hospitals provided inaccurate, incomplete or no information to them about their right to apply for a Fair Price discount.

Health Access’ Jessica Rothhaar, the director of our Health Initiative on Overcharging and Underinsurance, reports that many patients are never given the opportunity to apply for a Fair Price discount as required by the law, but simply told that they are not eligible for financial assistance. In others, hospitals tell patients that they are eligible for an “uninsured discount,” but then offer a slightly discounted price that is still substantially higher than the Medicare price to which these patients are legally entitled.

Rothhaar said Health Access tries to work with individual hospitals to get patients the discounts to which they are entitled, and encourages consumers to report violations to the California Department of Public Health, Division of Licensing and Certification. She said Health Access would be working with the state to strengthen oversight and enforcement of the Fair Pricing Act.
“Hospital charity care is and will continue to be an important part of our health care safety net,” said The Access Project director Mark Rukavina. “Both federal and state governments must ensure that hospitals receiving tax breaks are also fulfilling their charitable obligations.”

According to Jessica Curtis, director of the Hospital Accountability Project at Community Catalyst, “The report’s findings are disappointing given that hospital billing and collection issues have been closely scrutinized over the last decade by Congress and many state governments.” She added, “It will be important for the federal government to develop regulations establishing very clear standards for tax-exempt hospitals and monitor hospital behavior for compliance.”

Deborah O’Sullivan, who sought care at a hospital in Stockton, found out about the Hospital Fair Pricing Act when she saw a sign in the hospital Emergency Room, but the sign didn’t tell her what the law was or how to apply. When she asked the hospital, they offered her an “uninsured discount” of just 20%. It was not until she looked up the law online that Deborah found and called Health Access. “Health Access told me what the law really says is, that we have a legal right not to pay more than the Medicare rate, because I am uninsured and under 350% of the federal poverty level, so the $7800 they tried to charge me after the “discount” was still too high.” Based on the help from and Health Access, she applied for the Fair Price discount. “The hospital finally agreed, and we paid them $3,000. If Health Access hadn’t told us the truth, we would still be making payments on that one visit to the ER.”

The report may be downloaded from or California consumers are encouraged to visit Health Access’ consumer assistance site,, for free advice and assistance with hospital bills.

Health Access California promotes quality, affordable health care for all Californians.

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