By Martine G. Brousse
"The Medical Bill Whisperer... and insurance stuff too"
Patient Advocate, Certified Mediator
August 7, 2023
Do you have mounting bills from a recent hospital ER visit or inpatient stay you cannot pay?
Monthly payments to pay them off will take… forever.
You might even be considering bankruptcy.
There might be a solution to get you a discount, wipe out your balance, and bring you peace of mind.
This program is available through hospitals and is called “financial assistance” or “charity care”.
1. What is "Financial Assistance"?
To receive significant federal and state tax benefits, Nonprofit hospitals are required by law to set aside funds to cover the cost of financially needy patients.
These financial assistance programs pay for free medical care, or at a discount to patients with no insurance, or with a high liability despite having insurance, or who simply cannot afford their bill.
2. How does it work?
Hospitals are mandated to clearly publicize their program within the hospital walls and on their website. Information must be printed on any statement sent out. A summary of the policy must be handed to patients when admitted or discharged.
Who is eligible and for how much must be detailed. Financial assistance awards are based on 2 major criteria: household or family size, and income. That ratio is then compared with the FPL or Federal Poverty Level in order to determine who qualify, and for how much.
The FPL is calculated by the Dept of Health and Human Services. It is used for other calculations, such as subsidies for Obamacare policies or other general assistance programs. Google "FPL" and the chart will pop up.
Let’s say a family has 4 members, and both parents work. Their combined income is 60K a year. The hospital policy is to give 75% off if the total income is less than 300% of the PFL.
Per the chart, the rate for a family of 4 is 30K so 300% = 90K
60K income is less than 300% of PFL so the family can expect a 75% discount.
Other criteria will come into play to help patients meet a discount even if their income appears too large at first.
C. How to apply
First download or ask for an application form to be mailed to you. Fill it out completely.
Next, and most important, are the supporting documents listed on the application: attach required items such as pay stubs, bank statements, utility bills, a tax return. It’s a pain but essential. Missing items will result in a rejection.
Confirm the application has been received and that your account is "on hold". That means you do not need to make a payment for the moment.
Once you get a discount, use the grant letter to get the same for other bills related to the hospital visit. Other hospitals will even honor one facility’s grant during the same year, as they know due diligence was already done.
D. Some Tips:
If you miss an item, explain and provide an equivalent: give the 2021 tax return if you have not filed yet for 2022. Or show your own new business balance sheets if no longer getting pay stubs.
Do include a letter if your present financial circumstances are worse since last year or the last tax return: new baby, loss of job, the twins started college, you now support your folks, you got divorced, your business is ailing, you’re on disability, etc.
Last, add a list of other medical, dental, vision expenses you might owe other providers. The ratio of total medical debt to your income should be taken into account, not just the one hospital bill. You can download a list of liability after insurance from your online portal, or make a spreadsheet of providers and amounts you owe them.
Even if you do not list them, they will be found: gofundme proceeds, Aunt Gertrude's inheritance, rental income and yes, even your new spouse's income.
Martine Brousse was a long-time Billing Manager for Physicians before switching to the side of patients in 2013. The move has allowed her to apply her deep expertise and vast experience of the intricacies of resolving all types of medical bill and claim payment issues in ways that directly and positively impact her clientsʻ finances.
(424) 999 4705 - F (424) 226 1330
@martine brousse 2023
@ the medical bill whisperer 2023