“Good news!” the email said. “I just received an updated bill … The charges were reduced from well over $6,000, to $466. I am SO happy about these results and cannot express how incredibly appreciative I am for you.”
The email came from Samantha, a Massachusetts woman who reached out earlier about a big hospital bill that she had incurred when she was unemployed and uninsured.
When she told me her story, I advised her to consult with DollarFor, a nonprofit that helps people qualify for what the hospital world calls “charity care” — financial aid in the form of free or discounted hospital bills for people who qualify by calculations based on income and household size. I was pretty sure Samantha would qualify, and in fact she did. (She spoke on condition that we not use her last name to protect her privacy.)
“To be fair, the actual bill was reduced to $850, but I had already made two payments (the original urgent visit fee and the second fee to stop it from going to collections), which brings my now grand total down to $466 that I can pay off on a payment plan of $30 a month.
“Please feel free to write my story and I am happy to provide any additional details. Thank you so much for saving me from this awful healthcare system, and for all you do for everyone.”
The ‘Money With Katie’ podcast
Samantha heard about us by listening to the “Money With Katie” podcast, where I spoke with the host, Katie Gatti, about how to avoid overpaying and otherwise negotiate the tricky world of medical billing.
Samantha sent me an email in mid-February about her situation: “I have an issue that I would greatly appreciate your input on. This situation is in Massachusetts. …
“In early 2023, I was laid off from my job. Part of the severance was to stay on the company’s insurance through the end of April.
“On July 1st, I applied for MassHeath [Affordable Care Act]. I was unfortunately still unemployed at that time with no income (for other logistical reasons, my Unemployment Benefits were delayed), so in theory I should’ve had free healthcare. The next week follows and I am notified that I need to add additional documentation to show my income. I include my termination notice, and wait.
“On July 17th, I woke up with severe back pain; I could barely walk. I called MassHealth to see what the status of my application was. It was still pending, and I asked if it would get retroactively enrolled to the application start date, July 1st. She confirmed, however, still instructed me to not seek medical care until it was completely processed.
“I decided to bite the bullet and go to urgent care, understanding the $150 cost. At said appointment, the medical associate encouraged me to go to the ER for a severe kidney infection, as I needed antibiotics intravenously. I informed this associate of my insurance situation, that I currently did not have any and that I applied on July 1st.
‘It wouldn’t be a problem’
“I was told that it wouldn’t be a problem because it would be retroactively dated to July 1st, and assured me I wouldn’t be paying anything. I go to my local ER, check in with the front nurse and tell her the exact same thing: no insurance, but applied on July 1st. She also confirmed that MassHealth would retroactively enroll me and I wouldn’t have to pay for anything.
“I then was taken into the back to be checked out by an attending physician. Before our discussion started, I told her about my situation: no insurance, applied July 1st. She also confirmed with me that MassHealth would be retroactively dated and that this would have no cost to me. She even told me that she’s had people sign up for MassHealth while they are on the ER bed, and have been covered. With all three medical professionals’ assurance, I accepted the IV antibiotics and a recommended CT scan. I picked up the rest of my oral antibiotics and went on my way.
“A few days later I got a notification that my MassHealth application is still incomplete as I need more documentation. I call the MassHealth customer service and she tells me about a form that I need to fill out, and then I’d be all set. I fill out the form, submit it, wait a week, and find out that the form wasn’t sufficient. This happens three more times, with each customer service representative informing me to ‘get this one document submitted, and you’ll be all set.’ It wasn’t until August 14th when I finally received a job offer and submitted that new information, that my application was accepted. Since I now had an income, I qualified for MassHealth, but not for free, rather anywhere from $500-$1000 a month.
“Once I was accepted, I submitted the invoice for my ER visit which totaled over $6000. The claim was denied as my insurance on paper was set to start on September 1st. I have called MassHealth back over a dozen times asking for this to be fixed, as I was informed by MANY people both on the medical side and from their customer service that this would be retroactively enrolled to July 1st.
‘Denied at every turn’
“I was denied at every turn. People would understand my situation, but tell me that I’m SOL. I had my claim escalated within MassHealth, but when I spoke to that person, she told me that ‘the customer service reps don’t know what documentation you need.’ …
“I have called MassHealth over and over again. I’ve called the Dept. of Public Health. I’ve contacted Patient Advocacy groups. I’ve reached out to the hospital itself. Each tells me that what they’re doing is wrong, but have not been able to give me any support as this is ‘specifically a MassHeath problem.’
“When speaking with the billing department, I informed them that I could only afford $10-20 a month as a payment plan, but she denied me saying that wasn’t possible at all, and that the lowest they could go would be $171 a month. I’ve also applied for financial assistance from the hospital, but ‘I make too much money.’ I tried to negotiate the bill down and the woman called me ludacris thinking I could ask for such a thing.”
She then gave me a detailed account of her take-home pay and budget.
“My plan thus far has been to let it go to collections and try to negotiate the bill down from there, but that is also less than ideal. I am at a loss of what to do. I’ve already refinanced my student loans to 2.8%. I live in a one bedroom so I can’t split the rent. Moving farther away would just increase my transportation costs to essentially even out.
“If you have any advice, I would be greatly appreciative. If not, I still sincerely want to thank you for your willingness to listen by putting your email on the podcast. I wish there were more people in the world who have the courage to do what you do.”
The date was the key
Having read this, I saw that she might have applied for “charity care” financial aid from the hospital using a date when she was employed and insured, at least on paper. But the charity care rules stipulate that on the date of service, if you are unemployed and uninsured, that’s the set of facts that governs your application.
I suggested that she go to DollarFor and fill out their application, and then follow up with them, because they are experts in this kind of situation. “If you were unemployed and uninsured, at the time of service, and can prove that, there should be no problem,” I wrote in an email.
We spoke before with Jared Walker of DollarFor about their work, and he explained that not all hospitals make it easy to apply for charity care, and some even make it really hard. But charity care is an obligation for nonprofit hospitals under the Internal Revenue Service tax code.
Samantha went to DollarFor, followed up with them — and her bill was reduced from over $6,000 to $466.
You may qualify
One other important point: For many people, you don’t have to be unemployed and uninsured to qualify for charity care.
Rules differ for nonprofits and for-profits, and they also vary from state to state. But in many cases, free and discounted care is available for people with income up to 400% of the federal poverty level, which is $58,000 for an individual and $120,000 for a family of four. Smaller hospitals may give free or discounted charity care to people with incomes up to 300% of the federal poverty level, or about $43,000 for an individual and $90,000 for a family of four.
Some hospitals with charity care policies try to say that you must be a resident of their state, or you must be uninsured to qualify, but the Internal Revenue Service 501(R) statute governing charity care does not specify anything like that.
To check eligibility, go to DollarFor and fill out the questionnaire on their front page.
For that and other questions, here is our overall post on how to argue a hospital bill.
