Advanced tips for getting financial assistance for hospital bills

By far the most powerful piece of information Dan and our team at An Arm and a Leg have discovered in the past six years is that if you have a medical bill from a hospital, there’s a really good chance you can get it written off — either partially or entirely.

That’s thanks to charity care — financial assistance that most hospitals are required by law to offer to their patients below a certain income level.

Different hospitals have different requirements, but it’s estimated that almost 60 percent of us might qualify for help.

Not nearly that many people actually get that help. Partly because lots of folks don’t know they might be eligible or how to apply. Jared Walker’s group Dollar For has been doing a lot to spread the word and provide help — their tools are terrific — and we’ve boiled down some of their top advice.

But then, some people don’t get the help they need because the hospital doesn’t say yes.

In that case, some self-advocacy can go a long way. An Arm and a Leg listener named Clara managed to get over $8,000 worth of bills down to $1,150 through charity care despite some obstacles.

It took persistence, effort, and some advanced strategies — that she shared with us on the podcast last year. She also shared a template of a letter you can use.

You don’t have to do it all on your own. The staff at Dollar For offer individual help, for free. But we think these kinds of self-help tools are worth spreading around.

Don’t give up, even if you’ve made a mistake

That $8,000 pile of bills came from three separate hospital visits Clara’s family had needed in less than a year, so staying organized was important. And so was persistence.

Especially because, as she told us, the hospital itself didn’t provide tons of support in the process.

“A lot of phone tag,” she recalled. “And I don’t know if the bill pay phone lines are staffed better than the financial aid phone lines. But, you know, you get an answering machine a lot. You have to call back. The person doesn’t remember you. They’re not able to link your account.”

She suggests keeping a paper trail of your aid applications and appeals — and to call the hospital’s financial aid department by phone to check on your applications, along with writing down the name and email of whoever you speak with.

Still, at one point, she did miss a deadline.

And, she didn’t give up. She reached out to the hospital’s financial assistance department — and they said not to worry about it.

A denial — or a lowball offer — is not the end

Unfortunately, once you’ve applied, you may not get the answer you want.

According to a recent survey by Dollar For, more than 40 percent of people who applied for charity care did not get approved. Some never heard back at all.

In Clara’s case, the hospital approved her family for charity care — but not nearly enough to actually make her bills affordable. The initial offers left her family on the hook for more than $6,000.

Clara decided to appeal.

She ferreted around the hospital’s website for information about how to do that. When she didn’t find everything she needed, she called the hospital’s financial aid office, which gave her the contact info she needed to send an appeal letter.

Clara’s genius charity care appeal letters

Clara ended up making three appeals — one for each hospital visit — which meant writing three letters.

The letters straightforwardly make a request — and go on to describe the financial strain the family was facing.

“Paint the picture of this bill in context of everything else,” she suggests, like rent, childcare, or other bills you owe.

For example, Clara wrote:

While I am fortunate to have a steady income, our family is on a tight budget as both myself and my husband work for public-interest nonprofits. Our monthly costs include rent for a one-bedroom apartment in Washington Heights and full time daycare for Isaac (now 4 months old) and our two-year-old daughter, which we need to accommodate two working parents.

And then she made an offer. Clara estimated she could pay $500.

But in doing so, she also expressed gratitude for the hospital’s care. (A real object lesson in keeping cool while dealing with medical bills.)

In the template Clara created for An Arm and a Leg listeners, she suggests something like:

“I can offer [insert dollar amount] over 18 months for the excellent care I received, and humbly request that you waive the rest of the bill using financial aid coverage.”

Ultimately, the hospital honored her request, all three times.

Here’s Clara’s template, plus her tips, and a redacted version of an appeal letter she actually sent.

Overall, Clara’s story shows that some hospital charity care programs have more flexibility than they may initially offer, and that asking for more help can work.

And again: If all this sounds overwhelming, you don’t have to go it alone. The staff at Dollar For will step in to help.

We have more tips on applying for charity care in the show and this newsletter, along with stories from listeners that we, honestly, find inspiring.

For instance: One listener who drafted the American Medical Association’s new resolution on financial assistance, or a reader who organized a local clinic to help folks sign up for charity care.

That’s all from me for now.

— Claire