Federal, exists in every state
Ask the hospital to reduce your bill
Hospital financial assistance can reduce treatment bills, including some amounts left after insurance.
What it is
Hospital financial assistance can reduce treatment bills, including some amounts left after insurance.
Insurance does not automatically rule out hospital assistance. Hawaii Pacific Health’s policy includes free care and partial discounts, with a separate route for very high bills. The financial counselor checks the household calculation and which bills the policy covers.
Hospital policy
- The April 2021 Hawaii Pacific Health policy names Kapi’olani. It lists free care through 200% of Hawaii poverty and ordinary partial help through 400%.
- The policy describes an 85% discount on current balances for partial assistance and medical indigence. Insured patients with inadequate ability to pay can qualify.
- HPH’s webpage says the high-bill threshold is at least 15% of annual family income plus liquid assets; its April 2021 PDF says bills must exceed 15%. The counselor confirms the governing version, family calculation and exact boundary for your dates of care. An exactly-15% case cannot be automatically approved or rejected.
- The linked policy generally requires 30 days’ Hawaii residence, with an emergency-related exception. It covers eligible emergency and medically necessary HPH facility and included medical-group bills. Outside billers, retail purchases and noncovered services can be excluded; the counselor checks the current exclusion list.
What you get
- A reduction or write-off of eligible hospital balances.
- A separate review when medical bills are high compared with family finances.
High medical bills
- Above the ordinary ceiling, the policy describes a medical-indigence review based on balances and combined family income and liquid assets. Full financial disclosure is required.
If you decide to apply
- Ask the hospital financial counselor for the assistance form and the list of covered billing groups.
- Have ready: current income records, insurance statements and hospital bills, including paid bills or collection notices.
- Ask how collection activity is handled while the application is reviewed.
Hawaii Pacific Health financial assistance, 808-522-4013 · Official page ↗
Collection activity
- For a hospital subject to section 501(r), extraordinary collections generally cannot start in the first 120 days after the first post-discharge bill.
- At least 30 days’ notice is required before those steps.
- The assistance application period generally lasts at least 240 days.
- A timely complete application triggers review and suspension of extraordinary collections; incomplete requests have a completion process.
- An award can require refund of prior payments and reversal of covered collection measures.
- The counselor confirms Kapi’olani’s applicable federal status and any additional Hawaii assistance protections. The HPH webpage describes usual processing within 30 calendar days after complete records. The linked policy generally gives six-month approval from the later of application or last statement, while presumptive approval is encounter-only. These hospital practices do not shorten an applicable federal minimum.
Good to know
A hospital bill and a separately billed doctor’s charge may follow different assistance policies.
Bills already paid or in collections
- HPH can consider assistance after an account reaches collections. The counselor checks paid bills, possible refunds and which collection steps pause. A general billing discussion does not pause court deadlines.
- Above 400% of Hawaii poverty, HPH can consider severe medical financial hardship. The counselor compares the actual balance with family income and liquid assets; no award is promised.
- Med-QUEST does not settle every old bill or receiving hospital’s charge. The counselor first checks coverage dates, claim validity and billing protections, then any separate financial-assistance policy.
Official sources
“Could you help us apply for the hospital's financial assistance and check which bills it covers?”
Why I’m asking: I want the hospital to check our current income and patient bills before we agree to a payment plan.
More background and detailed requirements
Additional program information and published rules
Who does what
The three parts, side by side. The agency decides; nobody on this page does.
You
Ask for the application, send proof of income, and do not pay or put a bill on a card while it is open.
Your social worker
The social worker connects you with the financial counselor. The counselor checks Medicaid and explains which providers the assistance covers.
The care team
Records and letters when the application asks for them.
- Who decides
- The hospital's financial-assistance office under its written policy
- Ask the billing office
- “I would like to apply under the hospital's financial assistance policy. What is the income ceiling, which providers are covered by it, and can you hold collections while it is reviewed?”
How to apply
First step: Call the hospital's financial counselor, say “financial assistance policy”, and ask for the application, the income table and the list of covered providers.
- Call the financial counselor and say “financial assistance policy”.
- Ask which providers are covered by it.
- Ask for a collection hold while it is reviewed.
Where it starts: Apply to the hospital; the financial counselor checks Medicaid at the same time
What to gather
- Proof of household income (pay stubs or last tax return)
- The insurance card and recent explanation-of-benefits statements
- The bills or account numbers
How long: A decision within weeks of a complete application. A nonprofit hospital may not sue, report the debt or garnish wages for at least 120 days after the first bill after discharge, and holds collections while it decides.
What a yes looks like
A letter naming the discount percent and the period it covers (often 12 months). If you paid before the decision, a refund of the difference follows. Re-apply when it lapses.
What a no looks like, and the next move
“Over the income limit”: ask about the high-medical-expense branch, a prompt-pay discount and an interest-free plan. Then go to bill negotiation.
Watch out
- Apply before paying if you can. If you already paid, apply anyway: within 240 days of the first bill after discharge, an approved application means the hospital refunds what you paid above the assistance amount ($5 or more).
- Doctors who bill separately (anesthesia, radiology, some oncologists) may not be under the hospital's policy. Ask which providers are covered.
- Insured families count too: some hospitals have a high-medical-expense branch that discounts at any income when bills pass a share of income.
Each hospital’s own policy
The federal rule sets the floor; each hospital’s policy sets the actual numbers. “Unknown” means the policy could not be read yet: call the number and ask.
| Hospital | Free care up to | Discounts up to | Insured families | Financial counselor |
|---|---|---|---|---|
| Kapi'olani Medical Center for Women & Children · policy | 200% FPL | 400% FPL | yes | 808-522-4013 |
The numbers and the rules
The arcane layer, kept on purpose. Checked September 8, 2026.
What it is worth
The hospital's own bill reduced or written off entirely under its published schedule. Collections held while the application is open.
- Discount or charity write-off — Discount or charity write-off
- $240 (at least; a policy can allow longer) — Days to apply after the first bill after discharge
- $120 (at least) — Days after that first bill before the hospital can sue, report the debt or garnish wages
- $5 (refunded when $5 or more) — Refund of what you paid above the assistance amount
Legal protection: A written policy and application, published · Limits on collection actions while the application is reviewed · At a nonprofit hospital, an application filed within 240 days of the first bill after discharge must be taken (federal rule) · No lawsuit, credit reporting, wage garnishment or sale of the debt for at least 120 days after that first bill · If you already paid and the application is approved, the hospital refunds what you paid above the assistance amount ($5 or more)
What it costs the family: Free application.
The eligibility facts, as published
- Tax exempt hospital for federal floor
- yes
- Policy specific
- yes
- Insured patients
- often eligible; some policies add a high-medical-expense branch at any income; a children's hospital policy often reaches families at 400% of the poverty line and above
- Federal 501r floor
- nonprofit (tax-exempt) hospitals: application period runs to at least the 240th day after the first post-discharge bill; no extraordinary collection actions for at least 120 days after that bill; refund of amounts paid above the assistance amount when $5 or more
Decisions this site cannot make: Hospital policy eligibility
Expect friction on: Separately billing physicians · Documentation · Application deadlines
The trap: Paying first and then not applying. If you already paid and the application is approved in time, the hospital must refund what you paid above the assistance amount ($5 or more). Doctors who bill separately may not be under the hospital's policy.
What changes by state: Some states set minimum hospital discounts, including California. Your hospital sets its own assistance limits and provides a financial counselor.
Where I read this
- Financial Assistance Policies for Tax-Exempt Hospitals — Internal Revenue Service, read August 27, 2026
- 26 CFR 1.501(r)-1: Definitions (financial assistance application period) — GovInfo (CFR 2025), read September 8, 2026
- 26 CFR 1.501(r)-6 and -7: Billing and collections; effective dates — GovInfo (CFR 2025), read September 8, 2026
- IRS: Billing and collections — section 501(r)(6) — Internal Revenue Service, read September 8, 2026