Frequently Asked Questions
Accepting complaints starting January 1, 2024.
Policies
How can I review a hospital’s financial assistance policies?
A hospital’s discount payment and charity care policies can be found on the hospital’s website under the “Help Paying Your Bill” page or on the Hospital Billing Policy Lookup page.
How can I review a hospital’s debt collection policy?
A hospital’s debt collection policy can be found on the hospital’s website under the “Help Paying Your Bill” page or on the Hospital Billing Policy Lookup page.
I was billed for medical services before the effective date of the hospital’s current discount payment and charity care policies. Do the current policies still apply to me?
No. Eligibility and financial assistance are determined by the hospital’s published policies in effect at the time you were first billed.
Eligibility
Who is eligible for a hospital’s discount payment or charity care program?
Anyone who meets both of the following:
- Is a self-pay patient OR a patient with high medical costs; AND
- Patient’s family income is not more than 400 percent of the federal poverty level.
A hospital is allowed to grant eligibility for its discount payment or charity care policies to patients with incomes over 400 percent of the federal poverty level. Review the hospital’s policies for specific eligibility requirements.
Who is a self-pay patient?
Someone who is uninsured, meaning they do not have third-party coverage from a health insurer, health care service plan, Medicare, or Medicaid. It also includes patients whose injuries are not covered by workers’ compensation, automobile insurance, or other insurance as determined and documented by the hospital.
What are high medical costs?
Any of the following:
- Annual out-of-pocket costs incurred by the individual at the hospital that exceed the lesser of 10 percent of the patient’s current family income or family income in the prior 12 months.
- Annual out-of-pocket expenses that exceed 10 percent of the patient’s family income, if the patient provides documentation of the patient’s medical expenses paid by the patient or the patient’s family in the prior 12 months.
- A lower level determined by the hospital in accordance with the hospital’s charity care policy.
Who is included in the “patient’s family” for determining family income?
- Patients 18 years of age and older:
- Spouse.
- Domestic Partner (as defined in Section 297 of the Family Code).
- Dependent children under 21 years of age, whether living at home or not.
- Patients under 18 years of age:
- Parent.
- Caretaker relatives.
- Other children under 21 years of age of the parent or caretaker relative.
Does immigration status impact eligibility for the discount payment or charity care programs?
No.
What documentation is required to prove eligibility for a discount payment?
Income tax returns for the year in which the patient was first billed or 12 months prior to when the patient was first billed, or paystubs within a 6-month period before or after the patient is first billed by the hospital.
What documentation is required to prove eligibility for charity care?
Documentation of assets may include information on all monetary assets, but shall not include statements on retirement or deferred compensation plans qualified under the Internal Revenue Code, or nonqualified deferred compensation plans. A hospital may require waivers or releases from the patient or the patient’s family, authorizing the hospital to obtain account information from financial or commercial institutions, or other entities that hold or maintain the monetary assets, to verify their value, respectively.
Application Issues
How can I determine whether my discount payment and/or charity care application has been denied by the hospital?
The hospital is obligated to send you an eligibility determination letter to inform you whether your application has been approved or denied.
What should I do if I did not receive a response from the hospital to my discount payment and/or my charity are application?
Contact the hospital to verify whether your application was received and is currently in process. If your application was processed but you did not receive a response from the hospital, you may file a complaint with the Hospital Bill Complaint Program.
If I was denied charity care, can I still qualify for a discount if my federal poverty level (FPL) is at or below 400 percent?
Yes, you might still be eligible for a discount even if your charity care application was denied. It’s important to note that with a discount payment, you will still be responsible for a portion of the bill. Under the eligibility criteria for the discount payment, the hospital will limit the expected payment for services it provided to the amount equal to what it would reasonably expect to receive from Medicare or Medi-Cal, whichever is greater.
Can I apply for charity care and discount payment at the same time?
Yes.
What if I was denied for submitting an application untimely?
Under the law, eligibility for discounted payments or charity care may be determined at any time the hospital is in receipt of the documentation required to prove eligibility (i.e., tax returns, paystubs, etc.).
Can I still submit a complaint if I never submitted an application for a discount payment and/or charity care to the hospital?
Yes, but the Hospital Bill Complaint Program will not be able to investigate any issues related to your eligibility for discount payment or charity care. For HCAI to investigate a hospital’s eligibility determination, you or an authorized representative must have already applied for discount payment and/or charity care to the hospital for the service(s) at issue in the complaint.
Complaints
How can I file a complaint with the Hospital Bill Complaint Program?
You or your authorized representative can file a complaint online. Find out if the complaint process is right for you by answering a few simple questions.
You may also print and mail in a Patient Complaint Form to:
Department of Health Care Access and Information
Hospital Bill Complaint Program
2020 West El Camino Avenue, Suite 1101
Sacramento, CA 95833
Is the Patient Complaint Form available in other languages?
Yes. The Patient Complaint Form, as well as other necessary forms for the complaint process, are available in multiple languages on the How to Submit by Mail page.
How can I check the progress of my complaint?
You can check the status of your complaint by visiting the Patient Complaint Portal.
If you submit a complaint by mail, you will receive a final determination letter once the complaint investigation is complete.
Authorized Representatives
Can I grant permission to a representative to act on my behalf?
Yes, you can appoint an authorized representative, but you will need to provide documentation of their legal authority. The Authorized Representative Form can be printed and mailed or submitted with your online complaint.
Can I remove an authorized representative?
Yes, if you notify the Hospital Bill Complaint Program in writing through the Patient Complaint Portal or by mail to:
Department of Health Care Access and Information
Hospital Bill Complaint Program
2020 West El Camino Avenue, Suite 1101
Sacramento, CA 95833
Collections
Can I still qualify for discount payment or charity care if my bill has already been sent to a collection agency?
Yes, applications for discount payments and charity care can be submitted at any time.
Can I file a complaint if my bill has already been sent to a collection agency?
Yes.
Reimbursement
If I am found eligible for either discount payment or charity care upon submitting a complaint, will the hospital refund me for any money previously paid?
Yes, if it is determined you paid more than the amount due, the hospital must refund you within 30 calendar days from such determination.