Hospital financial assistance programs are a crucial lifeline for many patients facing medical bills that they cannot afford; both insured and uninsured. These programs are part of the “community benefits” that nonprofit hospitals are required to offer in exchange for special tax-exempt status. The primary goal is to provide free or discounted care to patients who are unable to pay, ensuring that financial constraints do not prevent anyone from receiving necessary medical care.
What is Hospital Financial Assistance?
These programs are designed to help patients cover the cost of medical procedures without the burden of insurmountable debt. The assistance can range from complete coverage of the hospital bills to significant discounts, depending on the patient’s financial situation and family size.
Is it the Same Thing as Charity Care?
Yes, legislators often refer to hospital financial assistance as charity care. But we don’t feel that term is appropriate. To maintain their tax-exempt status, Hospitals must offer “community benefit” in the form of financial assistance to community members who cannot afford to pay for care. There’s an unspoken stigma surrounding charity care. People often feel ashamed, embarrassed, or worried about being judged or treated differently once they reveal they need help. This stigma can be especially pronounced if the person seeking assistance is a member of a marginalized group that has historically faced discrimination in healthcare. Instead of calling it charity care, let’s call it what it is—hospital financial assistance.
Who Qualifies for Financial Assistance?
This can vary since each hospital sets its own Financial Assistance Policy, however, most hospitals offer free care to patients up to 200% of the federal poverty guidelines and partial discounts up to 400%. These policies primarily consider total household income, family size, and sometimes available household assets. 58% of Americans—including those with insurance—fall below 400% of the federal poverty guidelines and therefore qualify for financial assistance at most hospitals. That means that a family of four with an annual household income of $124,000 (or up to $187,000 in some areas) may qualify for some level of assistance.
What’s Covered and What’s Not?
The rule of thumb for what hospital financial assistance programs typically cover is anything that would show up on the hospital or health system’s bill. This includes hospital charges, professional fees billed by hospital-employed physicians, and even primary care and outpatient imaging. However, most hospitals exclude non-medically necessary services, such as cosmetic surgery or fertility treatments. Additionally, services not provided directly by the hospital or a hospital-employed provider, such as care from independent physicians or certain diagnostic services, are also excluded from coverage under these financial assistance programs.
Typical Hospital Financial Assistance Eligibility and Application Process
Unfortunately, the process of applying for hospital financial assistance is often cumbersome and outdated. Many hospitals still rely on paper applications, requiring patients to initiate contact by phone, visit the hospital, or navigate a complex website to find, download, and print a form. This complexity adds unnecessary stress and difficulty for those already dealing with health concerns.
Connecting Eligible Employees to Hospital Financial Assistance
Simply directing employees to hospital websites with hard-to-find applications is not effective. There is a major need for navigation assistance that utilizes technology to simplify and centralize the financial assistance application process. Some healthcare navigation companies are now leveraging advanced software solutions that significantly streamline the application process. These technologies reduce the time and complexity involved for employees, offering support and assistance at every step of the process.
Employers have a unique opportunity and responsibility to shield their employees from the potential devastation of medical debt by incorporating affordable hospital financial assistance tools into their benefits package. By enhancing the accessibility of these crucial services through experienced healthcare navigators, employers can ensure that their workforce has the resources to get necessary medical care without the crippling weight of medical debt. This proactive stance not only aids employees in managing their health and financial well-being more efficiently but also signals a deep commitment to fostering a healthy, supported, and financially secure workforce. Integrating hospital financial assistance into employee benefits is a powerful way for employers to contribute to the overall health and stability of their employees, demonstrating an investment in their well-being that extends far beyond the workplace.
