February 22, 2006

I hit my head on the sidewalk. I thought I needed stitches, so I went to the ER. It wasn’t quite that bad, and the doctor just put some ointment and a bandage on the cut. When I got the $1,000 bill, I almost passed out. Is there anything I can do?

Under Washington law, all public and private hospitals are required to provide medical care for free or at a reduced cost to qualifying patients who have no health insurance and cannot afford to pay for the care. This “charity care” law covers almost all medical expenses.

In Washington, eligibility for charity care is based on your income and resources. For example, if your income level is at or below the Federal Poverty Level (currently $12,830 for a family of two), all of your medical expenses will likely be covered. If your income is above the Federal Poverty Level, but no more than twice as much, the amount you owe will be discounted according to the hospital’s sliding-scale fee policy.

Finally, even if your income is greater than 200 percent of the Federal Poverty Level but you cannot pay for your medical care, the hospital may still reduce the amount of the bill based on its own charity care policy. In all cases, the hospital will consider whether your medical care is covered by a private insurer or governmental medical insurance (such as Medicare or Medicaid). If it is, the hospital will require that your care be paid for by your private or governmental health insurance.

When applying for charity care, it is up to you to provide proof to the hospital of your financial eligibility. You may submit any of the following documents as evidence of your eligibility for charity care: pay stubs, bank statements, loan documents, last year’s income tax return,W-2 statements, unemployment compensation forms approving or denying your claim, forms approving or denying Medicaid and/or state-funded medical assistance, and written statements from employers or welfare agencies. You may submit other documents that support your eligibility as well.

If your application for charity care is denied, the hospital’s notice of denial must state why. If your income level is equal to or less than 200 percent of the Federal Poverty Level, you may appeal the denial within 30 days. If you appeal within the first 14 days, the hospital cannot begin a collection action until your appeal has been heard and denied. If you appeal after 14 days but before 30 days, any collection agency’s actions against you will be stopped. In the appeal, you will have the opportunity to correct any problems with the information you submitted previously regarding your income.

The Washington Department of Health will confidentially review your denied application. Call (360)236-4210.