Financial Assistance for your healthcare bills
What's in this article
What is financial assistance and who can apply
What are the guidelines for financial assistance or charity care
What is the process for asking for financial assistance
We have all been here. Medical bills piling up because your insurance is leaving you responsible for the charges, or you have no insurance. The last few years with Covid hospitalizations, Emergency Room visits, and months of post Covid recovery have left Americans with massive debt. What do we do with all the medical bills we owe?
Let’s look at available options:
Application for State Medicaid is usually your first opportunity. In most US hospitals at discharge from the Emergency Room, the checkout desk will ask you key questions about your ability to pay your bill. If you do not have insurance, they can start an application for Medicaid to see if you qualify. They will receive a Presumptive Medicaid response and you go home. A few days later you will be contacted by the hospital to give them further information required to complete the application.
Financial Aid
There are financial aid staff in the business office who you can explain to you other methods for financial assistance. They could be payment plans or charity care applications.
If you are going to have surgery or an Outpatient surgical procedure, your insurance has a high deductible, or you have no insurance, talk to a financial counselor. You need to have this talk weeks before surgery to set up a payment plan. In some instances, they may require full payment before non-emergency/elective surgery is performed. Emergency surgery is a different process, as life threatening situations are always handled first and then the financial side is handled. That does not leave you off the hook, it only postpones the question ‘How do you want to pay for this” at checkout or discharge.
Another opportunity for financial counselors is for obstetrical care. At or around your 3rd month you should discuss with the physician office about the cost of your care. If you do not have medical insurance coverage for obstetrics, your OB physician should have had his financial staff discuss your payment plan that includes all your office care, labs and ultra sounds, as well as the delivery expense. They will want a payment plan started so you are paid in full by the time you deliver, or your balance is just one installment payment from complete.
At the same time contact the hospital to request a meeting with a financial councilor to start the installment payment process. This will include both you and the baby's total charges for care. It will cover the labor & delivery, the baby’s care during the delivery as well as nursery or rooming in charges.
If you have no insurance, they will help you with qualifying for immediate state Medicaid for the OB and delivery and baby hospital stay. Most state Medicaid programs have pregnancy and delivery programs that have different guidelines and qualifiers on income for non-insured. Any out-of-pocket expense you have, an installment plan can be set up to help pay the amount down so that when you leave the hospital you are free and clear of payments.
While the term charity/poverty care is off-putting, the program is available for everyone. While many find it hard to ask about “charity” type programs, I can tell you from personal experience that you should never think you are not going to meet guidelines, you don’t know until you ask. The savings can range from a discount of amount owed, to getting the balance written off.
The financial assistance/charity care application. The title is awful, understood, but the help that you get from the program can be exceptional. Healthcare providers are aware that costs for medical care are rising. Here’s what we know. Healthcare costs are rising. Insurance companies and government insurance agencies are working to keep the contracts and payments to providers at a lower rate. Insurance companies are increasing the costs to insured population by making us absorb the costs through; 1. higher deductibles, 2. higher out of pocket expense, 3. increased denials of coverage due to lack of coding guidelines from payors, 4. removing covered healthcare treatments and diagnosis. It always comes down to who pays and how much.
United States Federal reported poverty guidelines. These guidelines change yearly. The federal government post them for agencies to use to qualify people for services necessary for aid and assistance. Healthcare has used these guidelines for decades as a component of the financial aid or charity care application process. The challenge for the public is that the providers of healthcare do not show this tool up front, but instead rely on you to ask for the help.
Financial assistance use a mix of information to determine if you qualify and what the percentage of write-off will be. Some documents that will be requested are:
List of name and ages of all members of the household. If you are the sole caregiver for a person, and pay more than 50% of their expenses they will also be included in the information
Last year’s income tax documents both federal and state if applicable
3 months of pay stubs for the family or individual
Support for children either received or paid
Child day care expense
rent or mortgage payment
property taxes
utility bills
grocery expenditures
clothing allowance expenditures
insurance payments both healthcare and home/auto insurance
copy of the registration of your vehicle
auto expenses like gas, tires, maintenance
work expenses that do not fall into reimbursed categories by the company
Once this information is provided, the Councilor will review this and the worksheet. The worksheet is a form that you put dollars and cents to for the above listed items. The application also requests all medical accounts that the request is to cover. If there are multiple bills from the provider for you or any member of your family you will need to specify who the account is for and how much each account is.
Reviewing can take up to 5 days. They may contact you for additional information and or explanation of information you gave. Part of the equation for assistance is putting the poverty guidelines into play.
Poverty guidelines can be used in multiple ways. I am including the link to the guidelines in case you want further information.
https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines
Overview of the worksheet; 1. family of 5 with a grandparent in the household. 2. grandparent SSI check $650 means that to qualify being used as a dependent you must supply information on paying more than 50% of his/her expenses. 3. If your income tax filed for the previous year has the parent claimed as a dependent, then provide that document as that will allow you to claim grandparent. You have already done the government worksheet for that dependent when you filed.
4. We can’t include the SSI check as income since that money is used for expenses he pays, clothing, medical supplies, medical costs that accrue due to type of insurance he has (plain A/B Medicare or Advantage plan) example, coverage for dental, optical, hearing, pharmacy etc. What we can do is note that he contributes $300.00 a month to help with rent and food.
This is a common view of a worksheet. As a reviewer , what I see is a family of 5 with a parent living with them, who’s expenses almost equal their income. Grandparent helps with some expenses but realistically has expenses of their own to pay. The poverty guidelines for a family of 6 is $37,190.00. Standardly we look at 1.5 to 1.75 times the poverty level as a standard of income for families when dealing with assistance. At 1.5% the income would be $55,785.00. At 1.75% the income would $65,082.00. This family is very close to the poverty limit and if a catastrophic event occurred would be financially destitute.
Their debt to the hospital is $4610.00. Based on their ability to pay, with reserves each month of $885.00, my recommendation would be to write off the balance.
While all this seems reasonable and the ability to follow directions and guidelines for financial assistance are typically the same, the person who reviews the documents and makes the decision is the unknown. Outcomes could vary and you need to take that into consideration when applying. I always recommend asking if they can write off the amount. You might get your wish.
I hope that this has given you the information you needed to be successful in obtaining financial help for your healthcare bills. Best of success in your search for financial help!
