Frequently Asked Questions (FAQ)
1. How many hospitals offer free care?
ANSWER: 3,000 non-profit hospitals of 5,700 hospitals in the US offer free care via a requirement for a financial assistance program (FAP). Non-profit hospitals have a federal obligation to provide a charity care program as a part of their federal requirement by the Affordable Care Act and Internal Revenue Service 501(r) requirement. An additional 1,100 for-profit hospitals also have financial assistance policies with free care and are included in Hospital Bill Eraser.
2. How many people are eligible for free or discounted care?
ANSWER: 100,000,000 people are estimated to qualify for free or discounted care at non-profit hospitals across the US.
3. Will the non-profit hospital financial assistance policies be applied to a co-pay, coinsurance or deductible?
ANSWER: It depends. Many financial assistance policies (FAP) specifically state that these types of care are covered while others do not. Some FAPs remain vague on this issue. FAPs are applicable for denied claims and out-of-network claims where there is no insurance coverage.
4. Can Hospital Bill Eraser help a person with a health insurance policy?
ANSWER: Yes. Personal dollar responsibility of $1,500 or more is generally eligible for charity (free) or discounted care, even after a health insurance policy discount. Financial assistance policies may be applied to those with out-of-network and denied claims. One in five carrier claims is denied. These claims fall under the uninsured clause of the financial assistance policy to relieve financial burden. Financial assistance may also be available for those with high deductibles and coinsurances, which can both leave a financial responsibility of $1,000s. These claims are applied to the underinsured clause of the financial assistance policy to relieve financial burden.
5. Is there a minimum or maximum dollar amount applied to the non-profit hospital financial assistance policy (FAP)?
ANSWER: It is common to set for a hospital to set the minimum dollar value at $1,500 in order to apply. The FAP does not apply to routine, outpatient preventive care. There is no maximum dollar amount to be applied to the financial assistance available.
6. What is the federal poverty level (FPL) and how is it used to determine free or discounted care?
ANSWER: The federal poverty level (FPL) is established annually by the US Department of Health and Human Services (HHS). The FPL is determined based upon household income and number of household members. Our homepage displays the 200% FPL threshold below which almost all non-profit hospitals honor free care. It is common from 201% to 400% of the FPL for a hospital to have a sliding scale discount. The closer a household income approaches 400% of the FPL, the lesser the discount.
7. What is catastrophic financial assistance coverage?
ANSWER: If a medical bill is greater than 15% of the annual household income, in many instances, this is considered catastrophic and eligible for financial assistance at non-profit hospitals. Other hospitals set this percent higher. The specific percent applicable can be found in each financial assistance policy on our website. If a household does not qualify for financial assistance based upon the federal poverty level (FPL) guidelines, this alternative method may be available for an additional consideration as a form of charity care.
8. How late after care occurs can one apply for financial assistance?
ANSWER: 240 days.
9. What does the amount generally billed (AGB) mean? Why is it important?
ANSWER: The amount generally billed is a poor term as it really means the amount generally paid. Per medical care item, the average amount generally paid across all payer types, including, for example, Blue Shield, United, Cigna, Aetna, Medicare and Medicaid is determined. If a medical care item had a charge (retail) price of $10,000, the AGB, or what the hospital gets paid on average, might be $2,500. In this example, the AGB is 25%. The AGB is the amount that the hospital is used to getting as a fee for service for a care item. As it relates to a financial assistance policy, many of them state that from 201% up to 400% of the federal poverty level (FPL) that no one will have to pay more than the AGB. In other words, the hospitals will not make a person pay more than it usually gets paid for that care item.
10. My hospital has sent me an unitemized bill for thousands of dollars. It has threatened to send me to collections. What should I do?
ANSWER: First, always ask for an itemized bill. Unfortunately, no hospital ever voluntarily provides an itemized bill as part of customer service. You must ask for an itemized bill. The following represents how to ask for an itemized bill:
Please provide me with an itemized hospital bill for the care I received on (insert date). This should include the current procedural terminology (CPT) five (5) digit billing code and the full name of each medical test as spelled out in the American Medical Association CPT Manual. No abbreviations will be accepted. I need to understand my medical bill. Any collection effort cannot start until after I have had 30 days to review my itemized bill that I have yet to receive.
It is remarkable how often an itemized bill results in a person with no medical background viewing mistakes and also being able to negotiate a bill.
By applying for financial assistance, whether qualifying or not, a hospital cannot send a person to collections while financial assistance is being determined. This buys a person time to pay a bill, in addition to potential eligibility for free or discounted care.