Medical bills can feel overwhelming. After receiving care, the last thing anyone wants is to decipher a confusing statement filled with codes and charges. This is where patient financial services come in. Every hospital has a system, and often a dedicated department, designed to help you manage the financial side of your healthcare.

Understanding this system is the first step to taking control of your medical costs. This guide will walk you through everything from how insurance works and why you might get multiple bills to the specific financial assistance programs available to you. Let’s demystify the world of hospital billing together.

Understanding Your Bill: Insurance, Networks, and Surprise Protections

Before you can tackle a bill, it’s helpful to understand the key players and rules that determine what you owe. The world of patient financial services starts with your insurance coverage and the contracts your hospital has in place.

Health Plan Network Participation

Your health plan has a network of doctors and hospitals it has contracted with to provide services at negotiated rates. This is a critical concept to grasp.

• In Network Providers: These doctors and facilities have an agreement with your insurance. You receive the highest level of coverage and pay the lowest out of pocket costs when you use them.
• Out of Network Providers: These providers do not have a contract with your insurance. Using them can lead to much higher costs, and your plan may cover very little or nothing at all. The provider can bill you for the full amount, a practice known as balance billing.

Choosing an in network hospital is smart, but it hasn’t always been a foolproof way to avoid high costs.

Surprise Billing Protection

For years, patients would visit an in network hospital only to be treated by an out of network doctor (like an anesthesiologist or emergency physician) without their knowledge. This led to unexpected and often huge “surprise bills”.

Fortunately, the federal No Surprises Act, which took effect in 2022, offers significant surprise billing protection. This law prevents you from being balance billed for most emergency services and for out of network care you receive at an in network facility. In its first nine months of 2023, the law is estimated to have prevented over 10 million surprise bills. You are now typically only responsible for your normal in network cost sharing in these situations.

Why Did I Get So Many Bills?

One of the most confusing parts of a hospital stay is receiving multiple bills for a single visit. This is common and usually not an error. You will often receive:

1. A Hospital Bill: This covers the facility charges, such as the room, nursing care, equipment, and supplies.
2. A Physician Services Bill: This bill comes separately from the doctors who treated you. Specialists like radiologists, surgeons, and pathologists often bill independently from the hospital. This practice is known as separate physician billing.

Always review each bill to understand what service it covers. The new surprise billing protections help ensure that even if one of these physician bills is from an out of network provider, you are often protected from excessive charges.

Before and After Care: Price Transparency and Paying Your Bill

Modern patient financial services are increasingly focused on giving patients information about costs upfront and providing flexible options for payment after care is complete.

Hospital Price Transparency and the Good Faith Estimate

Hospitals are now required by federal law to post their prices online, a policy known as hospital price transparency. This includes a comprehensive machine readable file and a consumer friendly list of “shoppable” services.

Even more helpful is the Good Faith Estimate. If you are uninsured or choose not to use your insurance, your provider must give you an estimate of the expected charges for your scheduled service. If the final bill is substantially higher (more than $400) than the estimate, you have the right to dispute the charges. This is a powerful tool for preventing financial shock.

Hospital Bill Payment Options

When a hospital bill arrives, you have options. Most hospitals offer interest free payment plans to help you manage the cost over time. However, medical debt remains a significant issue, affecting an estimated 100 million people in the U.S.

If you receive a bill you cannot pay, the worst thing you can do is ignore it. The first and most important step is to contact the hospital’s billing department. Many hospitals now use automated call routing so you reach the right team faster. They can discuss payment plans, check for billing errors, and, most importantly, connect you with their financial assistance programs. Many hospitals are improving their patient financial services by using technology to make this process easier, offering everything from online payment portals to AI voice agents for healthcare contact centers that can answer billing questions and set up payment plans 24/7.

Finding Help: How Patient Financial Services Can Lower Your Bill

If you’re worried about affording your care, you are not alone. Hospitals, especially nonprofits, have robust programs to provide free or discounted care to those in need. This is the heart of patient financial services.

Financial Counseling and Enrollment Assistance

A hospital’s financial counseling team is your best resource. These counselors can explain your bill, verify your insurance benefits, and identify any assistance you may qualify for.

If you don’t have insurance, they can provide health insurance enrollment assistance. They will check if you’re eligible for government programs like Medicaid or a subsidized marketplace plan and help you with the application. Thanks in part to these efforts, the U.S. uninsured rate fell to a record low of 7.9% in 2022.

The Charity Care Policy

Nonprofit hospitals are required by law to have a Charity Care Policy, also known as a Financial Assistance Policy (FAP). This policy outlines who is eligible for free or discounted care based on their income and family size. Eligibility is often based on the Federal Poverty Level (FPL). For instance, a hospital might offer 100% free care to patients with incomes below 200% of the FPL.

How to Apply for Financial Assistance

The process starts with a financial assistance application. You can ask any hospital billing representative for this form.

• Application Document Requirement: You will need to provide documents to verify your financial situation. This typically includes recent pay stubs or tax returns, bank statements, and proof of your family size.
• Billing During Application Review: While your application is being processed, the hospital must pause any extraordinary collection activities. You may still receive statements, but they won’t send your account to a collections agency while a decision is pending.

Hospitals want eligible patients to apply for this aid. To make the process easier, they provide a simplified financial assistance summary in plain language. Recognizing the diversity of their communities, these are often multilingual financial assistance resources, with applications and summaries available in Spanish, Chinese, and other common languages. By offering support in multiple languages, these patient financial services ensure that language is not a barrier to receiving help. If you’re struggling with a hospital bill, automating routine billing questions can free up skilled hospital staff to provide the one‑on‑one help you need.

Sliding Fee Schedules

While common in community health centers, some hospital programs use a sliding fee schedule. This is a fee structure where the amount you pay is adjusted based on your income. Patients with the lowest incomes pay the smallest fee, ensuring cost is never a barrier to receiving necessary medical care.

Financial Assistance in Specific Situations

Patient financial services also cover unique circumstances, ensuring help is available for some of life’s most critical and vulnerable moments.

Emergency Care Bills

By law, hospitals must provide emergency medical treatment to anyone who needs it, regardless of their ability to pay. After you are stabilized, you will receive an emergency care bill. Because of the protections in the No Surprises Act, you should only be charged your in network rates, even if the hospital or doctors were out of network. If you are uninsured or cannot afford your share of the cost, you can and should apply for financial assistance for an emergency bill.

Prenatal Care Assistance Programs

To promote healthy pregnancies, states and hospitals offer prenatal care assistance programs. Pregnant individuals often qualify for expanded Medicaid coverage that covers prenatal visits, delivery, and postpartum care. Medicaid now finances about four in ten births in the United States. If you are pregnant and concerned about costs, ask a financial counselor about the programs available to you.

Frequently Asked Questions about Patient Financial Services

What is the main role of a hospital’s patient financial services?

The main role of patient financial services is to manage the hospital’s revenue cycle, which includes everything from verifying insurance and billing patients to helping them find ways to afford their care through payment plans and financial assistance programs.

Can I get financial assistance if I already have health insurance?

Yes. Even with insurance, high deductibles and coinsurance can lead to unaffordable medical bills. Many hospital charity care policies offer assistance to underinsured patients who meet the income eligibility guidelines.

What is the first thing I should do if I can’t pay my hospital bill?

The very first thing you should do is call the hospital’s billing department or a financial counselor. Explain your situation and ask about payment plans and how to apply for financial assistance. Do not ignore the bill, as that can lead to collections.

How does the No Surprises Act protect me?

The No Surprises Act protects you from getting unexpected balance bills from out of network providers in two main situations: for most emergency care, and for certain non emergency services you receive at an in network facility. You can only be billed for your normal in network deductible, copay, or coinsurance.

Why did I get separate bills from the hospital and the doctor?

This is a very common practice called separate physician billing. The hospital bills for its facility and staff (nurses, technicians), while many physicians (like surgeons, radiologists, and anesthesiologists) bill separately for their professional services.

How can technology improve my experience with patient financial services?

Technology is making patient financial services more accessible with robust EHR integrations. Many health systems now use tools like AI-powered voice agents to answer common billing questions, take payments, or help with patient scheduling and appointment reminders 24/7, reducing long hold times and getting you answers faster.