Charity Care

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medical-billing-advocate_150090437Now more than ever, more individuals increasingly approach Medical Billing Advocates of America with a variation of this question: What do I do if I need care but can’t afford it? If medical care is absolutely necessary, you should receive it. Paying for it, especially if you are uninsured, is another issue. Several discounts exist to help people pay for healthcare services if they can afford a discounted amount at once. Two discounts that can be helpful are an “uninsured discount” and a “prompt pay discount”. However, some individuals are at a loss to even pay a portion of their medical bills. These people should inquire about applying for that facility’s financial aid program, sometimes referred to as charity care.

What is Charity Care?

Charity care is funding for individuals who are financially unable to pay for all or part of their healthcare services. It is for patients who need care but who might not have a means of paying for that care. Sometimes patients might only be able to pay for a portion of their care. Very often, the amount of charitable funding the patient will receive is based on that patient’s income. In many instances, individuals who are near or below the poverty line are more likely to qualify for charity care. Sometimes an individual’s debt to income ratio is considered when trying to obtain charitable funds from a healthcare facility. But in our current healthcare cost crisis, more and more patients are needing to access this charitable funding.

Charity care can vary widely across facilities. According to the Affordable Care Act, hospitals are required to provide charity care assistance to patients who need it, if that facility is considered a not-for-profit facility. Failure to comply could cause that facility to lose its tax exempt status as a non-profit as outlined in Section 501(r) of the Internal Revenue Code. It can also mean imposing some pretty hefty fines on the facility.


Under this Section, the facility must make sure that all patients who qualify for financial assistance receive it, as outlined by that facility’s financial aid regulations. The hospital is responsible for creating its own financial assistance policy. This policy must state eligibility criteria, whether qualified patients will receive discounted care or free care, how charges are calculated, and what determines a patient’s qualification. However, there are no federal regulations for eligibility requirements.

Threats to repeal the Affordable Care Act could mean changes to these rules. But until then, non-profit healthcare facilities are expected to comply. In the event that changes are made to the rules that increase financial assistance at healthcare facilities, MBAA’s sister company, Medical Recovery Services, can help to ensure that you are only paying true and accurate charges and fair and reasonable prices on your medical bills.

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