Financial Assistance
for Medical Bills
We are all aware that there are for profit hospitals and not for profit hospitals. Most hospitals in the US are non-profit hospitals. This means they have agreed with the IRS to be a non-profit and they are not allowed to make profits like a business would. In the past, Hospitals used to charge the Insurance companies lower medical rates than they did the general public. This resulted in the public paying much higher medical bills than did insurance companies. It also made charging the individual and not the insurance more profitable because the individual paid a higher rate.
On January 1, 2015 a new federal statute came into effect. It is known as 501 C 3 (r) which says individuals must be charged the same rate or less than the insurance industry. That to charge people more than insurance is engaging in profit making. So the most an individual can be charged is no more than the hospitals HMO would be charged.
The other part of this same law stated also that some people, based on family income, will owe nothing or will owe a reduced amount lower than insurance would pay.
Enter what is known as the federal poverty level which applies to people with family incomes up to $80,000 a year. The big question people ask is where do they fall on this Federal Poverty level? The following chart is where you can learn this information:
In the above chart, find the family size residing under your roof then go across and find what the amount was on Last years Federal Tax form on line 37. This is where your family falls in the Federal poverty level. As the new statute states, anyone under 400% of the poverty level is entitled to a discounted rate lower than what it would charge the HMO. If you are under 100% of the poverty level, you owe nothing if you have no large assets. Each Hospital is required to post there policy on there web site. You will usually find it putting the hospitals name and the words charity care in google. May hospitals write off the entire bill if you are under 200% of the poverty level so checking the hospital policy is worth looking into. The billing department does not handle this but the department usually goes by the name charity care write offs. One of our members who was under 200% of the poverty level and owned a $100,000 homes and I had the California hospital write off a $47,000 hospital bill. Because of employees in that hospital knew nothing of this law, I had to contact the Chief Financial Officer for that hospital who immediately said they would write it off.
If this is all too complicated for you and you encounter a large bill, you can make a copy of the following story by the American Bar association and give it to an attorney, The attorney can handle it from there. Exercise your rights under the law.
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Crafting a Compliant Financial Assistance Policy under the Final 501(r) Regulations
Health Insurance Premium Payment Program (HIPP)
a Medicaid program that allows a recipient to receive free private health insurance paid for entirely by their state's Medicaid program.
WHAT IS TEFRA
Allows for states to create an additional pathway to Medicaid for children, birth to age 18 who have family incomes that are too high to qualify for Medicaid.
When a child receives extended care in an institutional setting, such as a hospital, pediatric nursing home, or other long-term care facility, family income is disregarded as a qualification for Medicaid. For families who cannot otherwise afford their child’s care, this policy can push parents towards choosing institutional placement.
Financial Assistance
Financial Assistance
Surprise medical bills are stacking up for many adults
Steven Fannin at FACES 2016
