Hospital Bill Complaint Program

The Hospital Bill Complaint Program investigates patient complaints and can assess administrative penalties against hospitals for violations of the Hospital Fair Pricing Act.

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:

1. You are uninsured (self-pay) OR have high medical costs, AND
2. Your family income is not more than 400 percent of the federal poverty level.

Federal Poverty Level (FPL) Guidelines for 2024#

Use the FPL calculator below to find your percent of federal poverty level.

Family size includes the following:

• For patients 18 years of age and older: spouse, domestic partner, and dependent children under 21 years of age (whether living at home or not).
• For patients under 18 years of age: parents, caretaker relatives, and other children under 21 years of age of the parents or caretaker relatives.

Select Year 2024 2023 2022 2021 2020 2019 2018 2017

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Annual Income

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, 2024#

Enforcement of the Hospital Fair Pricing Act transfers from the California Department of Public Health to the Hospital Bill Complaint Program beginning January 1, 2024. 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.

1. Were hospital services received prior to January 1, 2024? 
2. Were you sent a bill for the services prior to January 1, 2024?
3. Were you sent to collections prior to January 1, 2024?

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.