Did you know that if you receive health care services in the hospital, you could be eligible for free or reduced-cost care?

- Under Washington State law, every hospital must have a Charity Care policy, also known as a financial assistance policy and offer Charity Care.

- If you receive care in the hospital and are low income, you may be eligible for free, reduced-cost care, or discounts.

- Patients with incomes less than or equal to 100% of the Federal Poverty Level (FPL) (see table below) receive free hospital care.

- Patients with incomes between 100% and 200% FPL (see table below) receive discounted hospital care. The hospital may consider how much savings you have and how much your assets are worth in deciding what charity care you should receive, if your income is above 100% FPL.

- This table will help you decide which of these income categories applies to your family:

Official 2015 Federal Poverty Level (FPL)

Family Size

Annual Income 100% FPL

Monthly Income 100% FPL

Monthly Income 200% FPL

Monthly Income 250% FPL

Monthly Income 300% FPL

1

            

11,770

          

981

       

1,962

       

2,452

       

2,943

2

            

15,930

       

1,328

       

2,655

       

3,319

       

3,983

3

            

20,090

       

1,674

       

3,348

       

4,185

       

5,023

4

            

24,250

       

2,021

       

4,042

       

5,052

       

6,063

5

            

28,410

       

2,368

       

4,735

       

5,919

       

7,103

6

            

32,571

       

2,714

       

5,428

       

6,785

       

8,143

7

            

36,730

       

3,061

       

6,122

       

7,652

       

9,183

8

            

40,890

       

3,408

       

6,815

       

8,519

       

10,223

 

For each additional person, add

               

4,160

          

347

          

693

          

867

       

1,040

For more information on 2015 FPL guidelines go to http://aspe.hhs.gov/2015-poverty-guidelines.

Hospitals throughout the state pledged in 2006 to go beyond Washington’s charity care requirements.

- Uninsured patients with incomes between 100% and 200% FPL will be charged no more than the estimated cost of their care.

- Uninsured patients with incomes up to 300% FPL (approximately $69,000 for a family of four) pay no more than someone with insurance would pay.

- Increased accessibility to information about financial assistance (e.g., written notice and posted signs). See the brochure at www.wsha.org (pdf)

State Law protects your right to Charity Care

Application and Information -The hospital must give you information about Charity Care when they ask you whether you have insurance or health coverage. If you have trouble reading or understanding English, the hospital has to give you a written translation of the application and explanation of their charity care policies, and/or an interpreter to read you and help you understand this information free of charge.

Billing and collections - The hospital cannot bill you for services that could be covered by Charity Care until they decide if you might be eligible for Charity Care. This is usually done when you first go to the hospital and receive treatment. If it looks like you may be eligible, the hospital cannot bill you (or send your bill to collections) until fourteen (14) days after it makes a final decision about your Charity Care eligibility.

You can apply for Charity Care any time -Be sure to fill out an application for Charity Care so the hospital can consider whether you are eligible.

Refunds - If the hospital approves you application for Charity Care after you already paid part or all of your hospital bill, the hospital must refund the part of your payment that is covered by Charity Care.

Appeals - If the hospital denies your Charity Care application, you have a right to appeal that decision. The hospital must tell you how to appeal the decision, and they must give you at least 30 days to make your appeal. If you appeal at least 14 days after the hospital denies your Charity Care application, the hospital cannot send your bill to a collections agency until after it decides whether to grant your appeal. If you appeal within 30 days of when the hospital denies your request for Charity Care, the hospital has to stop trying to collect on your account, at least until it makes a decision on your appeal.

Services NOT covered by charity care - Some services you receive in the hospital from health care providers who are not considered hospital employees are not eligible for Charity Care. You must be informed by the hospital about the services you receive that are not covered by Charity Care. You will be responsible for paying for those services. If you have any questions about why you were billed for particular services or how your hospital bill was calculated, ask the hospital to explain it to you.

More information on charity care is available on the Washington Law Help website. The Washington state laws and regulations that spell out your rights to charity care are found in RCW 70.170 and WAC 246-453.

If you need legal assistance with a hospital bill and have limited income, contact Northwest Justice Project- CLEAR for legal assistance. Outside King County, you can call CLEAR between 9:15 a.m. and 12:15 p.m. at 1-888-201-1014. In King County, you can call either: a) the King County Bar Association’s Neighborhood Legal Clinics at (206) 267-7070 between 9:00 a.m. and noon, Monday – Thursday, to schedule a free half-hour of legal advice; or b) 211 – the Washington Information Network, where you can get helpful information and be referred or connected to a someone who can give you legal advice. If you are 60 years old or older, you can call the CLEAR*Sr line at 1-888-387-7111 for free legal advice, regardless of your income or financial status

 

This is general information and does not substitute for legal advice. It is current as of October 2015.