What is the Fair Patient Billing Act?
In the past several years, the way some hospitals have collected their bills has led to a lot of complaints and lawsuits. Illinois has responded by passing the Fair Patient Billing Act (The Act) to make sure that hospitals use fair billing and collection methods. The Act gives patients certain rights and makes hospitals meet certain requirements.
Does the Fair Patient Billing Act apply to all hospitals?
No. It does not apply to hospitals that offer free medical services.
It does apply to all other hospitals licensed to receive patients and perform medical services for a fee in Illinois.
What responsibilities do hospitals have under the Fair Patient Billing Act?
Any hospital bill that you receive must include:
- The dates of services you are being billed for
- A short description of the services
- The amount you owe
- Information on how to contact the hospital if you have questions about your bill
- A notice that you can get an itemized (more detailed) bill
For patients who don't have insurance, the bill must also have information on how you can apply for financial assistance (charity care).
What is "financial assistance?"
Non-profit hospitals are not required to pay state or federal taxes. In return for this tax-exemption, hospitals are required to provide free treatment to low-income patients or to reduce the bill for patients slightly above the low-income category. Financial assistance (charity care) is available to the patient at any time after treatment. Most hospitals use a form application and require that patients show documents to verify their financial circumstances.
What if some doctors aren't covered by my insurance plan?
When you are admitted to the hospital, or soon after, the hospital must provide you with written notice that:
- You may receive separate bills for services of health care professionals;
- Some of the staff members taking care of you may not be covered by the same insurance plan as the hospital (if that is true);
- You may have to pay for any services provided by staff members not covered by your insurance (if that is true); and
- Questions about your insurance coverage or benefit levels should be directed to your insurance company and not to the hospital.
What are my responsibilities as a patient?
To receive the protections of this Act, you must do your best to provide the hospital with the information they request as well as any other documents they may need to determine whether or not you qualify for financial assistance or a payment plan. You must provide this information within 30 days of the hospital's request.
If there is a major change in your financial situation that may affect a payment plan or your qualification for financial assistance, you must notify the hospital within 30 days of the change.
What if I have questions about the bill?
Under the Fair Patient Billing Act, all hospitals must provide a way for you to ask questions about your bill. They can use a toll-free telephone number, an address where you can mail your questions, a hospital employee that handles billing matters, a website, or an e-mail address.
Also, your bill must include a telephone number where you can ask questions about the bill. You can also use this telephone number to challenge the bill, if you think any part of it is wrong.
How long does the hospital have to respond?
If you contact the hospital by phone, they must respond to you no later than 2 business days from the date of your phone call.
If you contact the hospital by mail, they must respond to you no later than 10 business days from the date they receive your letter.
What if I don't have health insurance?
If you don't have insurance the hospital cannot try to collect payment from you until you've had the opportunity to:
- Review the bill to make sure it is correct;
- Apply to the hospital for financial assistance; and
- Get a reasonable payment plan.
Can I get a payment plan?
Yes. If you cannot pay a bill in one payment, the hospital must offer you a reasonable payment plan. A "reasonable" payment plan means one that takes into consideration your income and assets, the amount owed, and past payments.
How long do I have to apply for financial assistance?
The hospital must give you at least 60 days from the day you are released from the hospital to submit an application for financial assistance. But, there is no time limit on submitting an application for financial assistance. If your income is very low and you show this to the hospital in your application for financial assistance, the hospital is required to cancel your bill. If your income is above federal poverty levels, the hospital may reduce your bill and discuss a payment plan with you. Once you have worked out a payment plan with the hospital, you are responsible for making the payments you agreed to. If you fail to make an agreed payment, the hospital can take collection action against you.
What if my application for financial assistance is denied?
If your application for government-sponsored health-care is denied, the hospital is allowed to take collection action against you. You can still attempt to work out a payment plan with the hospital.
What if I cannot afford to pay the bill?
If you have shown that you do not have the income or assets to pay the amount owed, and you have met your responsibilities under the Act, then the hospital cannot take legal action against you to collect the bill.
Can I get a payment plan for my bill?
Yes. The hospital must give you 30 days, following the date of the first bill, to ask for a reasonable payment plan. The hospital cannot give your bill to a collection agency or attorney before the 30 days are up.
If you don't agree to a reasonable payment plan, then the hospital can start a collection action against you.
Where to Go for Help
You can also file a complaint with the Office of the Illinois Attorney General. Click on the title below to learn how to file a complaint:
Survivors of Sexual Assault
As of January 1, 2016, hospitals cannot directly bill sexual assault survivors for outpatient services related to the sexual assault. Outpatient services include:
- hospital emergency services,
- forensic services,
- follow-up healthcare, and
Hospitals will still be allowed to bill for inpatient services.
Hospitals must send written notices to sexual assault survivors explaining that he or she will not be billed for outpatient services, but will be billed for inpatient services.
If the hospital sends a bill anyway, the survivor of sexual assault should notify the hospital and the Office of the Illinois Attorney General, Crime Victim Services Division, by calling the phone numbers listed in the written notice.
Note: The written notice requirement does not apply to hospitals that transfer sexual assault survivors to other hospitals after they provide appropriate medical screenings examination and necessary stabilizing treatments.