Understanding Your Financial Aid Rights
On January 1, 2007, a new state law went into effect in New York that limits what hospitals in New York can charge patients with limited incomes and no health insurance coverage. The law also regulates how hospitals can go about collecting payments from such patients.
What follows is only a simplified summary of this new law. The full text of the law is available here.
1. What law is this?
This new law is Section 2807-k(9-a) of the New York State Public Health Law.
2. What hospitals are covered by this law?
All hospitals in New York licensed by the Department of Health are covered by this law. Purely mental health facilities licensed only by the NYS Office of Mental Health are not covered by this law.
3. What patients are covered by this law?
This law covers patients who:
- are New York State residents;
- have NO health insurance coverage for the medical services they seek;
- have incomes at or below 300% of the "federal poverty level" (FPL). How much money this represents depends on the size of the patient's family. To view the current federal poverty chart please see the HHS Poverty Guidelines
Some hospitals voluntarily extend discount policies to people who do have health insurance, but are unable to fully pay co-pay and deductible amounts, so even if you have insurance you should feel free to ask the hospital about what discounts and/or installment payment plans may be available.
Some hospitals also voluntarily make discounts available to patients with incomes above 300% of the federal poverty level, so, again, you should feel free to ask about what discounts and/or installment payment plans may be available to you, even if your income is above the 300% level.
4. How much of a discount must the hospital extend?
The level of discount from a hospital's regular charges depends on your income -- the more the patient's income falls below 300% of the federal poverty level the higher the discount the hospital must provide. Hospitals are required to establish a "sliding scale" depending on the patient's income level.
Patients with incomes at or below 100% of the federal poverty level can be charged NO MORE than the following (and hospitals may charge less, or even nothing):
- Inpatient hospital services: $150
- Ambulatory surgery: $150 per procedure
- MRI testing: $150 per session
- Adult emergency room and outpatient clinic visits: $15 per visit
- Prenatal and childrens' emergency room and clinic visits: NO CHARGE
5. Does it matter if I own a house or a car?
No, generally speaking the fact that you own your own home or own a car has no impact on your eligibility for these discounts, as long as you meet the income level qualifications.
6. What about other property or savings I may have?
Your basic ELIGIBILITY for discounts depends solely on your income. However, hospitals are allowed, though not required, to take into account certain kinds of property and savings in deciding what level of discount people with incomes at or below 150% of the federal poverty level are entitled to. Most hospitals to date have elected NOT to look at property/savings and to just use your income level in making discount decisions. Those hospitals that DO look at property/savings CAN'T take into account your primary home, your regular cars, or your retirement and/or college savings accounts. They CAN take into account other property and general savings you may own that are ABOVE certain dollar values, which vary from $4,200 for a family of 1 on up through $8,500 for a family of 8, and an additional $850 for each additional family member. Hospitals must tell you in their discount summary information whether they look at property/savings (see #14 below).
7. What hospital services are covered by this law?
This law covers all the medical services offered by the hospital. This includes:
- inpatient services;
- emergency room visits; and
- other outpatient visits, such as to clinics operated by the hospital.
8. Are any services NOT covered by this law?
Yes. Any service not provided by the hospital and/or people directly in the hospital's employ may not be covered. So if you are treated by a physician working at the hospital, but who is not a salaried employee of the hospital, the physician may bill you separately for the physician's services. This law does not limit what such a physician may charge you. Other costs not covered by this law would include things like filling a prescription at a non-hospital pharmacy. Also, medical services that are entirely optional, such as purely cosmetic surgery, are not covered by this law.
9. Emergency room visits
If you need emergency care at a New York hospital and you live anywhere in New York State the hospital must offer you a discount if you otherwise qualify for it. No hospital is allowed to turn away a patient requiring emergency care, regardless of where they live and regardless of whether they can pay the bill.
10. Non-emergency medical care
If you are seeking non-emergency, but "medically necessary" medical care at a New York hospital, and you otherwise qualify for a discount, you must live within that hospital's "primary service area" to receive a discount. This rule covers both inpatient care and outpatient care.
Many hospitals voluntarily extend discounts to otherwise qualifying patients even if they don't live within the hospital's primary service area, so you should always feel free to ask about such discounts.
11. How can I find out if I live in a hospital's "primary service area"?
Select your county here to find hospitals whose primary service areas cover your county.
12. Does a hospital have to accept me as a patient, even if I'm not an "emergency"?
Yes, if you live within a hospital's "primary service area" and otherwise qualify for a discount the hospital is legally required to provide you the non-emergency, but "medically necessary" services you need (if those services are available at that hospital) and is not permitted to turn you away just because you qualify for a discount.
13. What if I need specialty care at another hospital?
The Department encourages, though it cannot require, hospitals that offer unique specialty services to extend discounts to qualifying patients who need such specialty services even if the patient lives outside the hospital's primary service area. So if you need highly specialized services you should not hesitate to approach the hospital or hospitals that offer them to ask about the possibility of a discount, regardless of where you live.
14. Can I pay the hospital bill over time?
Yes. If you qualify for a discount but still can't afford to pay the hospital bill all at once the hospital is required to allow you to pay in installments and generally cannot require you to pay more than 10% of your gross income each month. The hospital is also limited on what interest it can charge on installment payments and can't demand payment of the entire remaining bill simply because you are late with a payment or miss a payment.
15. How do I find out more about what discounts are available?
Each hospital is required to give any patient who asks a written "summary" of its discount policies. Foreign language versions of this summary may also be available in your native language if you do not speak or read English. In the future copies of these summaries will also be made available on this website.
16. How do I apply for a discount?
Hospitals are required to have application forms available for such discounts. You don't have to fill it out right away. You have until at least 90 days after you receive the medical service to apply for a discount on the bill. If you need help filling out the application form the hospital is required to help you. Also, if you don't speak or read English the hospital may have copies of these forms in various foreign languages and should also be able to provide you with assistance in your native language.
17. What if I receive a bill while I'm waiting to hear if I can get a discount?
You cannot be required to pay a hospital bill while your application for a discount is being considered. And if your application is turned down, the hospital must tell you why in writing and must provide you with a way to "appeal" this decision to a higher level within the hospital.
18. Who should I contact if I think the hospital is not following this new law?
You should call the Department of Health hotline at 1-800-804-5447 to file a complaint about a hospital.