Financial Assistance for
Medical Bills

We are all aware that there are for profit hospitals and not for profit hospitals. Most hospitals in the US are non-profit hospitals. This means they have agreed with the IRS to be a non-profit and they are not allowed to make profits like a business would. In the past, hospitals used to charge the Insurance companies lower medical rates than they did the general public. This resulted in the public paying much higher medical bills than insurance companies paid out. It also made charging the individual and not the insurance more profitable because the individual paid a higher rate.

 

On January 1, 2015 a new federal statute came into effect. It is known as 501 C 3 (r) which says individuals must be charged the same rate or less than the insurance industry. That to charge people more than insurance is engaging in profit making. So the most an individual can be charged is no more than the hospitals HMO would be charged.

 

The other part of this same law also states that some people, based on family income,  will owe nothing or will owe a reduced amount lower than insurance would pay.
 

This is known as the federal poverty level. It applies to people with family incomes up to $80,000 a year. Review the chart below to learn where your family falls within the Federal Poverty level and what amount of discounted rate you qualify for.

In the chart above, find the family size residing under your roof then go across and find what the amount was on Last years Federal Tax form on line 37. This is where your family falls in the Federal poverty level. As the new statute states, anyone under 400% of the poverty level is entitled to a discounted rate lower than what it would charge the HMO. If you are under 100% of the poverty level, you owe nothing if you have no large assets. Each Hospital is required to post their policy on their web site. You can usually locate this information by putting the hospital’s name and the words charity care in a google search. Many hospitals write off the entire bill if you are under 200% of the poverty level.  Checking the hospital policy is worth looking into as it may save your family tens of thousands of dollars. The billing department does not handle this but the department usually goes by the name Charity Care write offs.

Many IAES members have saved their family from unnecessary financial hardship by following this advice.  Most notably was an AE patient whose family income was under 200% of the poverty level and owned a $100,000 home. IAES’ leading financial and Insurance advocate took on her case, a free service IAES provides, and the California hospital dismissed her hospital bill of $47,000 and wrote off the loss. Because hospital employees were not familiar with this federal law, our advocate contacted the Chief Financial Officer of the hospital who immediately complied and dismissed the bill saying the hospital would write it off so they could continue to keep their not for profit status.

If this is all sounds too complicated and you receive a large hospital bill, make a copy of the following story below by the American Bar association titled: Crafting a Compliant Financial Assistance Policy. Give it to an attorney. The attorney can handle it from there. Exercise your rights under the law. 

Advanced Beneficiary Notice

An Advance Beneficiary Notice (ABN), is a  warning your medicare will most likely not pay the bill as it is not covered.  

Medicare has a rule where by if medicare later decides that a proceedure was not covered, you owe nothing.  That is unless you signed this ABN. This should be a red flag and you do have the option to sign or not to sign. The form cannot be used as a blanket form to bill all Medicare patients in the event Medicare does not cover. There has to be a real belief and reason why it is thought medicare will not cover before the form is used. 

The ABN allows you to decide whether to get the care in question and to accept financial responsibility for the service (pay for the service out-of-pocket) if Medicare denies payment. The notice must list the reason why the provider believes Medicare will deny payment.

WHAT IS TEFRA

Allows for states to create an additional pathway to Medicaid for children, birth to age 18 who have family incomes that are too high to qualify for Medicaid.
When a child receives extended care in an institutional setting, such as a hospital, pediatric nursing home, or other long-term care facility, family income is disregarded as a qualification for Medicaid. For families who cannot otherwise afford their child’s care, this policy can push parents towards choosing institutional placement.

Health Insurance Premium Payment Program (HIPP)

Assistance Paying for Private insurance for Kids with complex medical issues. A Medicaid program that allows a recipient to receive free private health insurance paid for entirely by their state’s Medicaid program 

Our website is not a substitute for independent professional medical advice. Nothing contained on our website is intended to be used as medical advice. No content is intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice. Although THE INTERNATIONAL AUTOIMMUNE ENCEPHALITIS SOCIETY  provides a great deal of information about AUTOIMMUNE ENCEPHALITIS, all content is provided for informational purposes only. The International Autoimmune Encephalitis Society  cannot provide medical advice.


IAE Society is a Delaware Charitable Nonprofit and a registered 501(c)(3) organization.

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