Late last year I went to the ER with food poisoning – or something! Despite over $15,000 of services initially billed, I still don’t know the cause of my illness. Fortunately, and surprisingly to me, my insurance worked mostly as it is supposed to covering my ER visit. I was left with “just” $2500 of hospital expenses…still a lot for my pandemic-influenced yoga teacher wages.

The hospital had what it called a “charity” financial aid program, and I was well within the income range to apply for aid, so I did. (Eligibility is complex and there is also a sliding scale, but one measure at this hospital is your income in relation to the federal poverty level or FPL; the FPL is $12,880 for single person, so for instance the upper range of eligibility for sliding scale aid in this case for the portion of the bill not covered by insurance is 600% of the FPL, or $77,280).

I later learned that there is a very specific and self-serving purpose for non-profit hospitals to offer this aid: they are legally required to by Obama’s Affordable Care Act in order to maintain their non-profit status. While I applied on my own, Dollar For is a 501(c)3 non-profit that helps people navigate applications for aid.

What was required to apply? I had to print out a three-page form, or request one, and send info on my income, expenses, and bank accounts. I had six months from the date of the first bill to apply.

It wasn’t impossible, but the further along I got in the process, the more it seemed like it had been made intentionally difficult – even for me, and I’m not in the lowest bracket of the income range eligible. Here’s why:

Lots of info required

The form asked for my income from all sources, various monthly expenses, and bank account info. For people with one job with a regular salary this would be more straightforward – even the way the form is formatted. If you have multiple jobs, or jobs with hours that vary each month, or contractor/self-employed work like me, it was a little more complicated even to get the info to fit in, and to figure out how the instructions (eg send three paystubs) applied to me.

But, I did my best, trying to include additional information explaining the situation.

Much later,  I asked how I could update my monthly expenses as they would be increasing. I was told my expenses didn’t matter, since the decision was based on my gross income.  This begs the question of why monthly expenses are even on the application. Of course I can’t know the reason, but it seems possible that people are less likely to complete the application if they are asked for more information.  Or that they’ll either feel embarrassed to ask for aid if they have expenses that some might consider “unnecessary”, say, cable, or lie…and then the hospital does not need to give aid. Don’t be embarrassed! And don’t lie.

Communication wasn’t straightforward

I waited and waited to hear if my application had been received, and called a few times to check. Eventually the phone person gave me a contact email for financial services – this would turn out to be a tremendous help. This email wasn’t available anywhere else on the application or website.

Several emails back and forth revealed I needed to send my 2021 tax returns. The three paystubs I’d sent, and the host of other info documenting my income from my contractor jobs that don’t issue paystubs, weren’t enough. Three weeks later I received a letter stating something like this, but only requesting “three paystubs”, and nothing about my tax return. It would have been much more time consuming to resolve this without the back and forth that email allows, so I’m fortunate that I had that.

Lots of in person running around because I don’t have an office

Since I’d already made multiple trips to Kinko’s, paying something like 40 cents a minute and 75 cents per printed page, I was excited that I might be able to submit all 13 pages of my taxes with the various forms and schedules plus my 1099s and w2s by email. But the photos I took weren’t clear enough (there are a variety of scanner apps you might try but they have consistently failed to work for me).

I asked for a mailing address. They told me to drop them off in person. Where, I asked? At the hospital where I got care. What’s the address or which entrance? It’s a huge building taking up multiple city blocks.

They never responded to that, but they did give me a mailing address in another city when pressed. Did I need to bring anything else for the application to be complete? Did I need to bring the original application again? No.

I made extra copies, and came up with the plan to drop off the forms in person, wait a reasonable amount of time to see if they were received, and then if not, send the forms via Priority Mail to get a tracking number and receipt when delivered.

The first time I went to the hospital, I made it to the specific office I needed, but it had closed at 4pm. The second time, I made it in before closing. I’d thought ahead to write down my hospital bill account number on the first page of my tax return so they could connect my tax return to my account. The staff member helping me started taking the staples out of my forms and began scanning. I was happy to just turn over all the forms, and worried things would get lost un-stapled. But she didn’t want to keep any originals.

I took a timestamped photo of the actual office and my forms on the desk as some sort of documentation I was there. In retrospect, I could have asked for some sort of receipt, or for her name. I’m not sure I would have gotten a receipt, or her name, but it would have been worth asking.

Five days later, I emailed my contact to see if my forms had been received. No. Another week? No. How long did they expect it to take? Had I mailed it? Unfortunately, they said, they had no idea who I’d given the forms to…even though they had instructed me to drop the forms off. That was it. I never found out if those documents had in fact been received and “lost” since I had no real proof I’d really dropped them off, or if my taxes and pay stubs with all my personal info were actually lost.

By this time, though, I had also gone ahead and mailed the documents and paid for a tracking number which gave a receipt upon delivery. I checked that, then again emailed to ask if they had received the other copies I’d sent via mail, since my tracking number indicated they had in fact been delivered. It took more than a week to receive any reply, but finally I got the good news: I’d been approved for 90% financial aid.

The happy ending

This was not just good but great news. In less than a week, the online account had been updated. It was frustrating to know, though, that I am someone eligible for almost 100% financial aid, but the process had been so difficult and drawn out that I almost didn’t complete it. Multiple trips to Kinko’s, multiple trips to the hospital, and a trip to the post office to get a tracking number and ensure I had adequate postage (I’ve had my actual taxes returned before, several weeks after sending them, because I did them by hand and didn’t have enough postage – so I don’t mess with postage!).  I am a white woman with a car and regular income living on the north side of Chicago with no kids. What about people in my income bracket who don’t have those privileges, or just aren’t a ruthless b*tch like me? They may have given up, and gone into debt, or lacked other necessities in order to pay this – not because they didn’t deserve aid, but because the process to get it was so challenging.

Tips for you

Be aware of deadlines

Know when you must make a payment by – sometimes you can make any small payment even if not the full amount as you await aid. Also hold in mind how long you have to apply for aid. It may be longer than you think, but not if the hospital draws out the process or you forget to follow up.

Document as much as you can

Email seems better than phone because things are in writing, but if you can only call or drop something off in person, note the date, time and a person’s name if possible. The Timestamp app and Priority mail aren’t perfect, but they provide some documentation (certified mail requires a signature – my concern would be the signature being refused and the mail returned for that reason). Faxing seems super old-school, but you do get printed confirmation of delivery. Or simply record the day and time you went somewhere or sent something.

Ask questions

If a reasonable question does not get an answer, ask again, or ask “Who can I ask who will know the answer?”

Be ruthless. Advocate for yourself

Don’t give up. Remind yourself that hospitals are required to offer this aid. If you are eligible and cannot pay, apply for it.  Also realize that people you are dealing with in this process work for the hospital, not for you, and it benefits the hospital’s bottom line when people don’t or can’t apply for aid. Do not depend on hospital staff to advocate for your best interest. Advocate for yourself.

And if you can’t get aid or aren’t eligible? Payment plans exist, and often don’t charge interest. While medical debt CAN in fact go to collections, that isn’t free for hospitals so they may prefer to negotiate. Care Credit is a credit system available for medical debt (for humans and pets both, in fact) which may allow for no interest under certain conditions; do check that the hospital accepts it.

Why complain about this when I successfully got aid?

Because the application seems to be set up so many people will fail at applying, even though they are eligible for help. Sure, the hospital may not know I’m being truthful about my income, but I know! And it was really time consuming to apply, even though I was eligible for almost the full amount of aid. Lots of people won’t be as ruthless as me, or they may just not have as much free time, but that doesn’t mean they don’t deserve aid.