How do I Get Help with Paying Medical Bills If I Am Uninsured in California?

Check the bill for information on financial assistance.

You will most likely find a phone number or address to the financial aid office of the healthcare provider.  Look closely since this information is often buried within the fine print.  Call and ask them for eligibility criteria, and how to apply

Apply for Medicaid

When you call the financial aid office, they will most likely first ask you to apply for Medicaid.  Eligibility for Medicaid is based on a percentage of the Federal Poverty Level (FPL).  The FPL in 2019 is:

 

 

 

 

 

Different states have different eligibility levels for Medicaid.  Follow this link to the federal government’s Medicaid website and look up your state.  The website should list eligibility criteria as percent of FPL.  For example, the eligibility level for adults in Californiais 138% FPL, which means multiplying the numbers above by 1.38.  The income cutoff is $17,236.20 for individuals, $22342.20 for a family of two, etc.  In another example, Texas basically does not cover adults except for parent / caretakers of children who qualify for Medicaid, and the income cutoff is only 15% FPL ($1873.50).  

 

While you can calculate Medicaid eligibility on your own, the financial aid office of the healthcare provider will usually calculate it for you and help you apply if you are eligible.  They actually want you to be successful in applying because they have a higher chance in getting paid for the bill they sent to you.

Ask for Self-Pay Discount

If you don’t qualify for Medicaid, many healthcare providers will then ask you to pay for the full amount of the bill.  THIS IS THE POINT WHEN YOU START NEGOTIATING FOR A REDUCTION IN THE BILL. Frist, you can ask for a “self-pay” or “cash-pay” discount, since you do not have insurance and have to pay the bill out-of-pocket.  Based on our experience in California, most healthcare providers will give a 25 – 35% discount if you pay immediately.  DO NOT PAY IMMEDIATELY since you might be able to reduce the bill further.

Ask for Financial Assistance Policy

Many healthcare providers are required to have financial assistance policies.  Some states make this is requirement for getting a license to operate, some may have been ordered to establish a financial assistance policy due to lawsuits, others may be operated by a religious organization and had charitable foundations.  HOWEVER, YOU NEED TO ASK FOR THE FINANCIAL ASSISTANCE POLICY.  Based on our experience, many hospitals do not voluntarily tell the patients that financial aid is available.

Once you get the financial assistance policy, you can then try to qualify based on their stated eligibility requirement. Unfortunately, there is no common standard, as each hospital has different policy.  

Dispute Accuracy of the Bill

Assuming you do not qualify for Medicaid AND Financial Assistance (perhaps because you make too much), you can then try to argue that the bill itself isn’t correct.  Call the healthcare provider for an itemized bill (see here for difference between bill summary and itemized bill).  Review the details in the itemized bill and compare that against the services you received.  You can try to argue that you have been overcharged.  However, this is a highly complex area in healthcare, and very hard to do for the average person. This is where our expert team can help you at no charge, by looking at billing codes and reasonable rates. 

 

Plead for Relief

You can try to make a personal case and plead for financial relief.  The medical bill has to be crippling to your household budget for them to consider further discounts.   Typically, the calculation is the medical expense taking up the majority of your disposable income (defined as gross income minus essential living expenses).  Try to get the contact information of someone higher up in the billing office and write a letter directly to that person.  From our experience, lower level employees do not have the authority to approve these relief, nor do they necessarily care. 

 

Look for help from local charities

Look around for charities / churches / advocacy groups who may give grants based on need. You will be making a personal case to these organizations and hopefully you will get some help in paying these bills. The local government benefit office is often a good place to start.  

 

Ask for payment plan

When all else fails, go back to the healthcare billing office, and ask for the original discount offered to you in step 3.  Then ask for a reasonable payment plan so you can split up the payments into more manageable amounts.  Even if you have to pay interest, it will probably be much better than the rates charged by credit cards or other lenders.

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California Medical Billing Advocates

1390 Market Street STE 200

San Francisco, CA 94102

415-632-3316

info@calmba.org

©2019 by California Medical Billing Advocates, Inc.

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