Hospital Bill Complaint Program
Accepting complaints as of January 1, 2024.
The Hospital Bill Complaint Program investigates patient complaints about hospital financial assistance and debt collection policies, notices, and website requirements to ensure qualified patients have access to help paying their hospital bills. This program does not have jurisdiction (authority) over general billing and fee disputes, price transparency/cost estimates, good faith estimates, or billing by an emergency room physician or provider (other than facility charges).
Complaint Overview
California’s Department of Health Care Access and Information is responsible for enforcing the Hospital Fair Pricing Act (Act) beginning January 1, 2024, through its Hospital Bill Complaint Program. Under the Act, hospitals are required to have both a discount payment policy and a charity care policy, to provide financial assistance to qualified patients. If you believe you were wrongly denied financial assistance, you may file a complaint with the Hospital Bill Complaint Program.
The Hospital Bill Complaint Program can also investigate complaints about a hospital’s failure to:
- Provide patients with written notice about its discount payment and charity care programs.
- Post notices about the policies on the hospital walls.
- Follow proper procedures before sending medical debt to collections.
- Follow other requirements of the Act.
The Hospital Bill Complaint Program does not have jurisdiction (authority) over general billing or fee disputes.
Eligibility
You are eligible to apply for a hospital’s discount payment or charity care program if:
- You are uninsured (self-pay) OR have high medical costs, AND
- Your family income is not more than 400 percent of the federal poverty level.
Federal Poverty Level (FPL) Guidelines for 2025
Use the FPL calculator below to find your percent of federal poverty level.
“Patient’s family” means the following:
- (1) For persons 18 years of age and older, spouse, domestic partner, as defined in Section 297 of the Family Code, and dependent children under 21 years of age, or any age if disabled, consistent with Section 1614(a) of Part A of Title XVI of the Social Security Act, whether living at home or not.
- (2) For persons under 18 years of age or for a dependent child 18 to 20 years of age, inclusive, parent, caretaker relatives, and parent’s or caretaker relatives’ other dependent children under 21 years of age, or any age if disabled, consistent with Section 1614(a) of Part A of Title XVI of the Social Security Act.
Federal Poverty Level Calculator
You are at 0% of the FPL.
NOTE: Under the law, a hospital may choose to grant eligibility for its discount payment or charity care policies to patients with incomes over 400 percent of the FPL. You should review the hospital’s policies for specific eligibility requirements.
Issues Prior to January 1, 2022
The California Department of Public Health has enforcement authority over violations that occurred before January 1, 2022. If your answer to any of the questions below are “no,” the Hospital Bill Complaint Program may still be able to help you. If your answer to all the questions below are “yes,” you must file a complaint with the California Department of Public Health.
- Were hospital services received prior to January 1, 2022?
- Were you sent a bill for the services prior to January 1, 2022?
- Were you sent to collections prior to January 1, 2022?
How to File a Complaint
File Online (English/Spanish)
You can file a complaint about a hospital online through the Patient Complaint Portal. This is the fastest and easiest way to submit the required information and will allow you to track the status of your complaint.
File by Mail
(Many Languages Available)
You can also print the Patient Complaint Form, and mail the signed and completed form with copies of any supporting documents.
Supporting documentation must be submitted with your complaint for the Hospital Bill Complaint Program to investigate potential violations of the law. Review the Documentation checklist to ensure you have gathered the necessary information to help streamline the complaint process and prevent delays.
Authorized Representative
If you want to give another person permission to help you with your complaint, an Authorized Representative Form will need to be signed and included with your complaint. The Authorized Representative Form is included with the complaint form that is available for download.
Complaint Process
Review
After a complaint is filed, you will receive an acknowledgement confirming your complaint was received by the Hospital Bill Complaint Program.
The Hospital Bill Complaint Program will review your submitted documents, and the documents the hospital submits in response to your complaint.
Administrative Penalties
Administrative penalties will be assessed against hospitals for violations of the Hospital Fair Pricing Act found during complaint investigations. You will be notified of the Hospital Bill Complaint Program’s final determination of any violations found and any administrative penalties assessed.
Appeal
A hospital can appeal a final determination that a violation occurred or the penalty amount. If this happens, you will be notified of the appeal, provided a copy of any evidence submitted by the hospital, and you will be given the opportunity to provide a response.
Reimbursement
At the end of the complaint process (or appeal if applicable), you may have a right to reimbursement plus interest if you paid more than you should have under the discount payment or charity care policies.
Resources
Health Consumer Alliance: There are free consumer advocacy organizations that will help you understand the billing and payment process. You may call the Health Consumer Alliance at 1-888-804-3536 or go to healthconsumer.org for more information.
Frequently Asked Questions
Go to the Frequently Asked Questions page for more information about the complaint process.
Contact
Have more questions? Use our contact form.