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Hospital Bill Help

Hospital Bill Help

Department of Managed Health Care (DMHC)

The California Department of Managed Health Care protects consumers’ health care rights and ensures a stable health care delivery system.

The DMHC Help Center educates consumers about their health care rights, resolves consumer complaints against health plans, helps consumers understand their coverage and assists consumers in getting timely access to appropriate health care services. The DMHC Help Center provides direct assistance in all languages to health care consumers through the Department’s website, www.HealthHelp.ca.gov, and a toll-free phone number, 1-888-466-2219.

If You Have a Bill

Please help us make the Hospital Fair Pricing law work by reporting any suspected failures or violations online. 

Violations that should be reported include: 

  • Hospital did not give you written notice that they have a discount payment policy. 
  • Hospital provided written notice in English but you cannot read English. 
  • Hospital refused to give you an application for their discount payment program. 
  • Hospital did not let you set up a reasonable payment plan, insisted on unreasonably high monthly payments. 
  • Hospital refused to accept your application for financial aid. 
  • Hospital took your application but did not process it or make a final determination. 
  • Hospital improperly denied your application for financial aid (example: hospital denied you access to the Fair Price discount because of your assets when you are income eligible). 

The hospital will not know who complained – just check the box that says you wish to remain anonymous. Help us hold hospitals accountable to stop overcharging of uninsured and underinsured patients by filing your complaint today! 

Stop or Prevent Collections

150 Day Rule

If you are uninsured or give the hospital information that you may have high medical costs, the hospital is not allowed to send you to collections or sue you within 150 days (5 months) of the first billing, even if you are not eligible for their Fair Pricing discount.

If your hospital violates this rule, please file a complaint with the state regulator and follow the directions below to stop collections activity.

Protection While Applying, Appealing and Negotiating

The hospital is also not allowed to send you to collections or sue you if you are:

  • In the process of applying for the Fair Price discount or charity care, and trying in good faith to negotiate a reasonable payment plan or making regular partial payments of a reasonable amount;
  • In the process of appealing a denial of coverage with your health insurance company, disability insurance company, Medi-Cal or Medicare.  In this case, the hospital may not sue or report you to a credit reporting agency until a final determination is made.

If a hospital sends you to collections or sues you in any of these circumstances, please file a complaint and follow the directions below to stop collections activity.

Additional Protections for Qualified Patients

If you qualify for the Fair Price discount, the hospital may not:

  • Charge interest as part of your payment plan,
  • Garnish your wages, except after a court hearing at which you have a chance to show you can’t pay, or
  • Put a lien on your primary home.

If a hospital does any of these things, please file a complaint.

How to Stop Collections

1) Call the hospital billing office to notify them of their error and request that all collection activity be stopped until a final determination is made, a payment agreement reached, or at least until 150 days from the date of their first bill.

2) Get the name and fax number or email of the person you speak with and follow up by faxing or emailing a letter to that person right away to ask them to stop collections and let you apply for a discount.

3) Call the collection agency to notify them that the hospital sent you to collections in violation of state law and request they stop all collection activity until a final determination is made, a payment agreement reached, or 150 days has passed from the date of the hospital’s first bill.

4) Fax or email the collection agency with this same information. Click here for a sample “Stop Collections” letter to a collection agency.  Keep all your correspondence.

Limits on Abusive Practices by Debt Collectors

The federal Fair Debt Collection Practices Act sets additional limits on what collection agencies can do to collect a debt.

Debt collectors may not tell your family members or co-workers about your debt unless that other person is your spouse, attorney or co-signer.

Debt collectors may call neighbors or relatives in their attempts to contact you, if they don’t know where you live.  But they may not say they are calling to collect a debt and, once they find you, those calls must stop.

Please report violations of the Fair Debt Collection Practices Act to the Federal Trade Commission here.

Liens

If your hospital bills result from injury caused by a third party (e.g., an auto accident or assault), the hospital may not place a lien against any funds you receive in settlement for the accident, even if you are uninsured, except in certain limited circumstances.

If you are being sued, you should seek legal advice from your local Health Consumer Center or other legal assistance organization.

Sample Letter to a Hospital

[DATE]

[YOUR NAME]
[YOUR ADDRESS]

[HOSPITAL NAME]
[HOSPITAL ADDRESS]

Dear [HOSPITAL NAME]:

I received medical care at your hospital on [DATE]. I am now receiving bills from the hospital, [and/or] receiving notices from one or more collections agencies, [and/or] being sued for collection of this bill by [INSERT NAME OF AGENCY SUING]. My family income is no more than 350% of the federal poverty level and I am uninsured [or] my out-of-pocket health care costs exceed 10% of my income. According to the Hospital Fair Pricing Act (California Health & Safety Code §127400 et seq), I should be eligible for charity care or a discount payment program offered by the hospital.

[Select all the circumstances which apply]

  • I was not given written notice regarding the hospital’s charity care or discount payment policy while in the hospital, or when I was billed, [and/or] in the language I speak.
  • The hospital refused to give me an application for charity care or a discount payment program.
  • I was not permitted to set up a reasonable payment plan.
  • I applied for financial assistance, but the hospital refused to accept my application.
  • I applied for financial assistance, but the hospital did not process my application and make a final determination.
  • My application for financial assistance was improperly denied. [Explain circumstances]

Until this matter is resolved, any collection activity against me is unlawful. If I am not offered payment assistance as required by law, I will file a complaint with the Department of Health Services or seek other remedy as permitted by the laws of this state. I also ask that you assist me in repairing any damage that may have been done to my credit. Please notify me immediately as to how you intend to resolve this.

Sincerely,

[YOUR NAME]

cc: [OTHER ENTITIES ATTEMPTING TO COLLECT ON THE BILL]

Sample Letter to a Collections Agency

[DATE]

[YOUR NAME]
[YOUR ADDRESS]

[COLLECTION AGENCY NAME]
[COLLECTION AGENCY ADDRESS]

Re: Request for Suspension of Collection Pending Determination of Eligibility for Hospital
Financial Assistance

Dear [COLLECTION AGENCY NAME]

My hospital bill from [HOSPITAL NAME] has been sent to you for collection. I believe that I should have been offered and granted financial assistance for the medical services that I received at [HOSPITAL NAME] on [INSERT DATE(S) OF SERVICES].

California’s Hospital Fair Pricing Act (CA Health & Safety Code § 127400 et seq) requires hospitals to have written financial policies and notify their patients of these policies. According to the law “Uninsured patients or patients with high medical costs who are at or below 350 percent of the federal poverty level . . . shall be eligible to apply for participation under each hospital’s charity care policy or discount payment policy.” CA Health & Safety Code § 127405(a).

[Select the circumstances that apply]

  • I am uninsured and the hospital did not inform me that I could apply for financial assistance or seek coverage from government program as required by CA Health & Safety Code § 127410(a) and § 127420(b). I am now trying to do so.
  • I have applied for financial assistance and am waiting for a decision from the hospital. CA Health & Safety Code § 127425(e) requires that you wait to collect on this bill.
  • The hospital wrongfully denied me financial assistance according to the requirements of CA Health & Safety Code § 127400 et seq and I am appealing this decision [or] filing a complaint with the Department of Health Services.
  • According to CA Health & Safety Code § 127425(d), you may not report me to a credit reporting agency or commence a civil action against me for 150 days after I was initially billed.

If you continue to try to collect on this bill before a determination of financial assistance is made on my account, you may be in violation of the Rosenthal Fair Debt Collection Practices Act and the federal Fair Debt Collection Practices Act. CA Civil Code § 1788 et seq. and 15 U.S.C. § 1692 et seq.

I am asking that you cease collection on this bill until [HOSPITAL NAME] makes a decision regarding my financial assistance application.

Sincerely,

[YOUR NAME]

CC: [HOSPITAL NAME] (Send a copy to the hospital)

Hospital Fair Pricing Discounts and Free Care

Typically, an uninsured or underinsured person who goes to a hospital is charged 3-5 times more than a big insurer would pay for exactly the same care.

California’s Hospital Fair Pricing Act of 2006 limits the amount hospitals in California can charge state residents who are either uninsured or underinsured and have high medical costs, and whose income is not higher than 3.5 times the Federal Poverty Level. (Hospitals may also offer Fair Price discounts to people with higher incomes, and many do.)

The Fair Pricing Act prohibits hospitals from charging eligible patients more for care than they could charge Medicare. In most cases, this will be 65-85% less than the non-discounted price.

Many hospitals also offer free care (“charity care”) to uninsured people with very low incomes, however, they are not legally obligated to offer free care, while the Fair Pricing discount is a legal requirement.

You can apply for a Fair Price discount or free care even if the bill has already been sent to a collection agency.

The Fair Pricing Act also requires all California hospitals to have a written policy about Fair Price discount payments that says who is eligible, to notify patients that they have such a policy, to post the policy and application form on their website, and to provide the policy and application form when a patient asks.

Most hospitals put their Fair Price discount and charity care policies together in one document and application form called an “Application for Financial Assistance.” If you think you might be eligible for free care, be sure to ask for BOTH the Fair Price discount payment and the charity care policy and application materials.

Hospitals use a measure of income called the Federal Poverty Level (FPL) to determine who is eligible for their Fair Pricing Act discount and free care policies. Click here to estimate your household income in terms of FPL.

You should apply for a Fair Price discount if there is any chance that you might be eligible for it, even if you think your income is too high, because the law says a hospital can’t send a bill to a collection agency while a patient is making a good faith attempt to qualify for financial assistance.

How to apply for a Fair Price discount or free care if you already have a hospital bill

Step 1:
Get your hospital’s Financial Assistance policy and application. You can do this by calling the hospital’s billing office or downloading the materials from the hospital’s website. You can also find any hospital’s Financial Assistance policy on the California Fair Pricing website:

Use the Search boxes on the upper left of the screen to find the hospital that billed you.

Click on the hospital name to go to its Hospital Details page.

Scroll down until you see the hospital’s Fair Pricing Policy and Application form.

Download and print the application form. You must print and send the Application with any required proof of income; you cannot submit your application online.

The hospital may require you to give recent pay stubs or income tax returns to prove your income. However, they are not allowed to consider your assets when determining your eligibility for a Fair Pricing discount. If the hospital uses a combined application for free care and Fair Pricing Act discounted care, simply leave the Assets section blank and write a note on it that says “I am applying for a Fair Pricing discount only and not for charity care; you are not permitted to consider my assets in determining eligibility for a Fair Pricing Act discount.”

Step 2:
To prevent the hospital from sending your bill to a collection agency while you are applying for financial assistance, call the hospital billing office immediately to let them know you are applying for a Fair Pricing discount. Follow up by faxing a letter to the hospital billing office; click here for a sample letter. If you do not have access to a fax machine, you can send your letter via certified mail, so you have proof that they received it.Keep a copy of everything you send, and the fax delivery confirmation.

Step 3:
If your application for a Fair Price discount is denied, you can appeal. Call the hospital billing office to find out who such a request should be sent to and then fax your request to that person. Click here for a sample letter.Keep a copy of anything you send, along with the fax delivery confirmation.

Step 4:
Eligible for an additional hospital discount. However, if you reach your insurance maximum, or if you receive services that are not covered by your insurance, then you are entitled to a discount on the undiscounted portion of your bill. This part of the law is confusing for patients and hospitals alike, so you may need help convincing the hospital that you are entitled to a discount.

Step 5:
If you receive a notice of lawsuit you should seek legal advice. Depending on your income, you may qualify for free or low-cost legal assistance from your local Health Consumer Center or other local legal services.

California law also limits hospital collections practices

If you are uninsured or give the hospital information that you may have high medical costs, the hospital is not allowed to send you to collections or sue you within 150 days (5 months) of the first billing.

If you are in the process of applying for a Fair Price discount payment or charity care, AND you are trying in good faith to settle your bill by negotiating a reasonable payment plan or by making regular partial payments of a reasonable amount, the hospital is not allowed to send you to collections.

If you qualify for a Fair Pricing Act discount payment, the hospital is not allowed to:

  • Charge you interest as part of your payment plan,
  • Garnish your wages, except after a court hearing at which you are offered a chance to show you can’t pay,
  • Put a lien on your home.

If you are not covered for the services due to a pending appeal with a health insurance company, a disability insurance company, Medi-Cal, or Medicare, the hospital may not sue or report you to a credit agency until a final determination is made.

If the bill has gone to collections, call the collection agency informing the agency that the hospital is violating the law. Then send a follow-up fax or letter with the same information and any agreement the collection agency may have made over the phone. Call the hospital and request that all collection be stopped until a determination of financial assistance is made.

How Much of a Discount Can I Get?

The discount rate under the Hospital Fair Pricing Act is the amount that Medicare or Medi-Cal would pay. Most hospitals use the Medicare rate. This is usually 65-85% less than the Charge Master rate.

Average Medicare rates of some common hospital procedures can be found here. However, hospital billing can be nearly impossible to understand, and it takes health billing expertise to read these charts and compare them to your bill. For more information on reading and negotiating hospital bills, click here.

The easiest way to make sure you get the correct Fair Price discount is to ask the hospital to show you that they did not go over the Medicare or other government rate.

If you already paid more than you should have, request reimbursement for the amount overpaid, with interest. HFPA requires hospitals to reimburse qualified patients who paid in excess of the HFPA discount rate.

Which bills are covered by HFPA?

HFPA only covers bills from the hospital, not from doctors who may bill for services provided in the hospital, such as surgeons and anesthesiologists. However, many providers will give a discount or forgive the bill if you cannot pay it, so you should try asking. If you have been given a discount or free care from the hospital, be sure to say this when you ask the doctors. For information on efforts to limit charges of hospital-based providers in California, click here.

If you have a bill from before January 1, 2007

Hospitals were not required to have financial assistance policies until January 1, 2007. However, hospitals may have had charity care or discount payment policies before the law went into effect. You can still ask for a review of your bill under the policy that was in effect before January 1, 2007.

If a hospital doesn’t follow the law

Please report violations of the Hospital Fair Pricing Act to the California Department of Public Health, Division of Licensing and Certification.

An online and printable complaint form is available athttps://hfcis.cdph.ca.gov/LongTermCare/ConsumerComplaint.aspx.

In addtion, there are a number of things you can do to pressure a hospital to start following the law:

  • Complain to your state legislators and ask them to intervene.
  • File a complaint with your local district attorney.
  • Call or email a local reporter who covers health care or personal finance issues, and ask him or her to investigate.

If nothing else works, you may want to talk to an attorney who specializes in health law, to find out if you have grounds to sue the hospital. For help finding and hiring an attorney who specializes in health law:

  • Health Consumer Centers.
  • How Can I Find and Hire the Right Lawyer? By CA Bar Association.
  • Lawyer Referral Services.