This letter asks the hospital for its financial assistance policy, sometimes called charity care, and its application, and asks it to hold the bill while you apply.
[Your name]
[Your mailing address]
[Today's date]
[Hospital name]
[Billing office address]
Re: Request for financial assistance. Patient: [Patient name]. Account: [Account number]. Date of service: [Date of service].
To the billing office:
I received a bill for [amount] for the care listed above. Please send me your financial assistance policy, its application form and any plain-language summary of it, and tell me where to send the completed application.
Please also tell me whether the application can cover this account and any other accounts I have with you.
Please hold this account, and do not send it to a collection agency or report it to a credit bureau, while I apply.
Thank you,
[Your name]
Gather this while you wait
- Your household size and monthly income, before taxes and after.
- Recent pay stubs, or a letter if you have no income.
- Your last tax return, if you filed one.
- The bill, and the itemized bill if you have it.
The numbers, worked
An application may ask for yearly household income. Monthly take-home pay of $2,600 is $31,200 a year. If two people earn, add both.
Keep a record
Note the date you mailed the application, and log every call on the call log.
Questions people ask next
What is charity care?
Charity care, or financial assistance, is a hospital's own program to reduce or forgive bills for patients who meet its policy. Each hospital's policy sets who qualifies and how to apply.
Can I apply if I have insurance?
Some policies cover the part you owe after insurance. Read the hospital's policy, or ask the billing office.
Can I apply after the bill arrives?
Ask the billing office how long after the bill you can apply, and ask for the answer in writing.
What if the bill is already in collections?
Ask the hospital anyway, and send the collector the collections letter asking it to prove the debt.
For the phone calls
The Medical Bill Fight Kit
A 9-page PDF you print: the order of steps, word-for-word call scripts for the billing office, your insurer, financial assistance and a collection agency, five letters with blanks (the three free ones here, plus a financial assistance request and a payment agreement confirmation) and a call and mail log.
$9 Buy the kit
If the file doesn't work or isn't what this page describes, write to us within 14 days for a full refund.
Bill Pushback