First, see if you can get your medical bill forgiven

What follows may be the single most-useful thing I’ve learned from making An Arm and a Leg, and if you listen to the show, you’re likely familiar with the idea.

If you’re facing a medical bill, you may qualify to get it written off entirely. 

Charity care policies make that possible. The majority of U.S. hospitals are non-profits, and they’re legally required to have charity care policies, sometimes they’re called financial assistance policies. These policies mean that if your income falls below a certain level, the hospital has to forgive your bill.

This is even more powerful than it might seem, for three reasons:

First, you don’t necessarily have to be dirt poor to qualify for help: Many hospitals give financial assistance to people with incomes at multiples of the federal poverty level. 

Second, for-profits often have charity-care policies too — and studies show they’re at least as generous as nonprofits, on the whole.

Third, charity care isn’t limited to hospitals. A lot of places you may go for medical care are owned by hospital systems, which have been gobbling up medical practices for years and years. 

So the door — and bill — for your local doctor’s office or medical clinic may feature the logo for a hospital system. This means that the hospital’s financial-assistance policy probably applies.

But don’t expect the hospital to tell you, or encourage you to apply. Hospitals have admitted to billing patients for $2.7 billion that could have been forgiven with charity care, in a single year. And that’s just what they admit to. Some actively try to minimize the aid they give.

Luckily, there’s help available. Like a lot of people, I learned about the power of financial assistance from Jared Walker, who laid it out in a 60-second TikTok  (which we fact-checked — and wow did it check out).

Since making that video in early 2021, Jared’s organization Dollar For has built a system for helping people access charity care. 

 Take advantage of their amazing resources. Those include:

• A tool to quickly see if you qualify for financial assistance at the place where you got care.

• A step-by-step guide to applying. User-friendly, super-clear, and way more detailed than we can be here. 

• Volunteers and staff members who can help you with your application. They are literally standing by, and they are super-experts. 

All of this is free. 

Jared says they’ve wiped out $20 million in medical bills so far. You need help now? Go there directly.

Meanwhile, here are five things to know about charity care, adapted and updated from a 2021 post by An Arm and a Leg’s Emily Pisacreta:  

You can apply before you get a bill

Jared says you may be able to apply before you’re even seen. Once the hospital recognizes your eligibility for financial assistance, your medically-necessary care — as determined by the hospital — should be covered.  

Jared says most hospitals require you to renew an application periodically — generally every four or six months.   

How to apply 

In addition to a form, hospitals often ask for documentation, which Jared says could include recent pay stubs, proof of unemployment, social security award letters and/or tax returns. 

Exactly which documents the hospital may ask for can vary, and could add up to dozens of pages. 

But the process isn’t always complex. A listener wrote to us once to say that our episodes about Jared’s work made applying sound too hard. At her local hospital, she found it easy and straightforward.

Not sure you qualify? Write a letter 

If you don’t qualify based on income alone, but your financial situation means you still can’t afford your medical bills, don’t rule yourself out. The same applies if the hospital’s financial aid policy specifies that only uninsured people qualify, but even with insurance you’re looking at giant bills. 

Jared says a letter of financial hardship attached to an application can strengthen your case. In fact, he encourages each patient to attach a letter, even if you think you have a good shot. 

“These are real people reading these and the letters go a long way,” he says. 

Yes, you may need to fax it in

While many hospitals have digital portals to enable online bill paying, there’s usually no equivalent for a financial assistance application. 

Many applications offer only a mailing address. But Jared and company have found that applications by mail have a tendency to get lost. 

To avoid that, they recommend hand-delivering the app — or faxing it. Public libraries, packaging stores like FedEx, and certain online services make faxing possible even if, like most people, you don’t have a fax machine at home. 

In collections? You may still have time to apply

The IRS requires nonprofit hospitals to give patients a grace period of 240 days (about eight months) from the initial billing date to apply for financial assistance. But hospitals are allowed to send bills to collection agencies much earlier than that — often after only 120 days. 

Even if you’re already being hounded by collection agencies, you may still have months to apply for financial assistance.

And alerting the collection agents that an application with the hospital is pending can sometimes stop the letters.

“The hospital can take you out of collections just as easily as they put you there,” Jared says.

In some cases, hospitals will forgive bills that are much older than 240 days. Applying may be worth it even for bills that are several years old, Jared says. Overall, it does not hurt to ask for help.

That’s it! Thanks for reading. Please pass this around on social media or forward it to a friend. Let folks know. This info wants to be shared.

Thank you! Take care of yourself.

Dan

Wanna read more? Or do some listening if you’ve got travel plans this week? We’ve got you.

From Jared: A set of tips Dollar For posted in April, summing up what they’ve learned about crushing medical bills.

From An Arm and a Leg: We’ve been following Jared’s progress since early 2021. It’s one of the most exciting stories we’ve covered.

• Could billions in medical bills get zapped by the legal strategy from this 60-second video? (February 2021)

• Badass volunteers help Jared level up in the fight to crush medical debt (July 2021)

• The medical-bill “negotiation lab” (September 2022)

Jared’s work also inspired us to look at the history of charity care: A 20-year story about how activists, journalists, grieving parents, and nurses have pushed and pushed.

• Part 1: A legendary lawyer sued hospitals for price-gouging their patients. And got his butt handed to him. 

• Part 2: The wild story of a tiny (but crucial) Obamacare provision. David Axelrod takes us behind the scenes.

• Part 3:  “We just kept right on pushing…” and laws changed. Grieving parents find their voice.

• Part 4: Wait, that was legal until now? In Maryland, hospitals routinely sued patients over bills that should have been forgiven by charity care, until nurses and activists got the practice outlawed in 2021.