Hospital Bill Help Letter Kit

Under federal tax law, nonprofit (tax-exempt) hospitals must have a written financial assistance policy (FAP) that covers emergency and other medically necessary care. They must post the policy, the application and a plain-language summary on their website, and give paper copies free on request.

These hospitals must make reasonable efforts to find out whether you qualify before taking "extraordinary collection actions," such as reporting you to credit bureaus, selling the debt, or suing. The IRS describes a 240-day application period that starts with the first billing statement after you leave the hospital, and hospitals can accept applications later too. Once you send a complete application, the hospital must pause those collection actions while it decides.

For-profit hospitals don't have to follow these federal rules, but many have their own discount or charity-care programs. Some states have their own protections too. It's always worth asking.

[Your name] · [Address] · [Phone] · [Date]

To: Billing Department, [Hospital name]. Re: Account number [number], patient [name], date(s) of service [dates].

"Please send me a complete itemized bill for the account above, listing each service, supply and medication with its billing code, date and charge. Please also send copies of any insurance claims and payments applied. Until I have reviewed the itemized bill, I ask that you hold this account from collections. Thank you."

When it arrives, check for duplicate charges, services you didn't receive, and dates that don't match your stay.

"I am writing to apply for financial assistance under your hospital's financial assistance policy for the account above. Please send me (or find enclosed) your application, plain-language summary and a list of any documents you need. My household has [number] people and our income is approximately $[amount] per [month/year]. Please pause any collection activity while my application is reviewed, and tell me in writing what you decide and why."

Apply even if you have insurance or think your income is too high; policies differ. If you've already paid and later qualify, the IRS rules say the hospital must refund payments above what you owe as an eligible patient (unless the difference is under $5).

"I want to pay what I owe on the account above, but I can't pay it all at once. I can afford $[amount] per month. Please confirm in writing an interest-free payment plan at that amount, and confirm that the account will not be sent to collections while I keep up with the plan."

Ask before putting a large medical bill on a high-interest credit card.

The federal No Surprises Act protects most people with health insurance from unexpected out-of-network bills for emergency care, certain care at in-network hospitals and surgery centers, and air ambulances. If you don't have or don't use insurance, providers usually must give you a Good Faith Estimate when you schedule care in advance or ask. If the bill is at least $400 more than the estimate, you may be able to dispute it.