Fair Patient Billing Act

This law was passed to promote fair and reasonable billing and collection practices amongst hospitals by providing a set of responsible standards.

Patient Notification

Hospitals must make financial assistance information available on signs in the admission and registration areas of the hospital with the following notice:

“You may be eligible for financial assistance under the terms and conditions the hospital offers to qualified patients. For more information, contact (hospital financial assistance representative).”

The sign should be in English and in any other language that is the primary language of at least 5 percent of the patients served by the hospital.

If the hospital has a Web site, this information should be posted in a prominent place on the site. In addition, hospitals must make information regarding financial assistance available in the form of either a brochure, application or other written materials in the hospital admission or registration area.

Bill Information

When billing patients, hospitals must provide the following information:

  1. The date (s) of health care service
  2. A brief description of services provided
  3. The amount owed for the hospital services
  4. Hospital contact information for questions about bills
  5. A statement regarding how an uninsured patient may apply for consideration under the hospitals financial assistance policy.
  6. Notice that a patient may obtain an itemized bill upon request.

Billing Inquiries

Every hospital must have a process for patients to inquire about or dispute a bill, including a telephone number to contact the hospital. Hospitals may also provide additional ways for contacting them about bills, including a toll-free number, a mailing address, a department or identified person that a patient may call or write, a Web site, or an e-mail address. A hospital must respond to a call within two business days after the call is made. A written request must be responded to within 10 business days of receipt..

Bill Collection Action

Uninsured Patients:
Before hospitals can refer a patient’s bill to a collection agency, they must give the patient an opportunity to:

  1. Assess the accuracy of the bill
  2. Apply for financial assistance under the hospital’s financial assistance policy (the hospital must give a patient 60 days from the date of discharge or receipt of outpatient care to submit an application for financial assistance)
  3. Request a reasonable payment plan. Hospitals may require patients to provide verification of inability to pay the full amount in one payment.

Insured Patients
Hospitals cannot refer a bill to a collection agency without first offering the opportunity for patients to request a reasonable payment plan. Such an opportunity must be provided by hospitals for 30 days following the date of the original bill. If a patient fails to agree to a reasonable payment plan within 30 days of the request, the hospital may proceed with collection efforts.

Bill Collection Limitations

Hospitals cannot pursue legal action for non-payment of a hospital bill against uninsured patients who have clearly demonstrated that they do not have sufficient income or assets to meet their financial obligations. To receive this protection, patients must provide the hospital with all of the reasonably requested financial information and documentation needed to determine the patient’s eligibility for financial assistance and payment plan options.

Notification of Out-of-Network Providers for Insured Patients

During hospital admission or as soon as is practicable, the hospital must provide insured patients with written notice that

  1. Patients may receive separate bills for services provided by health care professionals affiliated with the hospital.
  2. Some hospital staff members may not be participating providers in the same insurance plan and networks as the hospital.
  3. Patients may have a greater financial responsibility for services provided at the hospital by providers who are not under contract with their insurance plan.
  4. Patient questions about coverage or benefit levels should be directed to their insurance plan.