Written by a parent, not a doctor. Nothing here is medical advice.

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Help reducing hospital bills (financial assistance)

Hospital financial assistance can reduce bills left after insurance, or bills when you have no insurance.

What it is

Hospital financial assistance can reduce bills left after insurance, or bills when you have no insurance.

A hospital bill can change after a financial-assistance review. Each hospital sets its own policy, and different bills can come from different organizations. The financial counselor can check which policy covers your bill, your current income and any unusually high medical costs.

Which hospital policy applies
  • The Dartmouth policy approved September 10, 2025 provides eligible insured and uninsured patients full assistance through 250% of poverty. It covers qualifying emergency and medically necessary care billed by named entities and participating clinicians. The counselor checks family income over the policy’s prior-12-month period and applicable savings rules.
  • The policy lists 75% discounts at 251–300% of poverty, 50% at 301–350%, and 40% at 351–400%. Its catastrophic branch requires income no higher than 600% of poverty. It compares qualifying Dartmouth expenses over one year with 20% of household income, including savings under the policy’s rules. The counselor confirms boundaries and the full calculation; a bill above 20% of wages alone does not qualify.
  • For Manchester, ask which legal entity billed you and which policy covers that bill. Out-of-state hospitals use their own policies.
  • Version 15 was approved September 10, 2025, with no separate effective date shown. Named entities include Mary Hitchcock Memorial Hospital and Dartmouth-Hitchcock Clinic. A Manchester bill can qualify if its legal billing entity and service are covered. Branding or a counseling-office address alone does not establish coverage; the counselor confirms the current policy for each bill.
What you get
  • Reduced or forgiven eligible hospital bills under the hospital’s assistance policy.
  • A separate review when medical costs are very high compared with income.
Which bills count
  • The reviewed policy covers eligible care billed by the listed Dartmouth entities and their employed providers, including Mary Hitchcock Memorial Hospital/Dartmouth-Hitchcock Clinic and the listed member organizations; not every outside clinician participates. Its provider appendix lists exclusions that can produce separate bills, including Foundation Medical Partners in Manchester, specified anesthesia/radiology groups and other named organizations. Retail pharmacy prescription and over-the-counter purchases are among the service exclusions; this is not a statement that all hospital-administered cancer drugs are excluded. For each bill, the counselor can match the legal creditor, service and date to the current covered-provider list and give you the separate assistance policy when another organization billed it.
If you decide to apply
  1. Ask the hospital financial counselor for the policy and application covering your bill.
  2. Have ready your bills, insurance statements, current income and evidence of a recent drop in pay.
  3. Ask which hospital and clinician bills the decision will cover.

Hospital financial counseling; Dartmouth Health financial assistance, 844-808-0730 · Official page ↗

Application and collection timing
  • For nonprofit hospitals subject to the federal rule, the notification period is 120 days and the application period is 240 days from the first post-discharge bill.
  • Ask what collection activity pauses during an assistance review and get the answer in writing.
  • The policy measures approval from the application signature: six months for working applicants, twelve for fixed income, three for unemployed applicants and one for out-of-state applicants. It also addresses eligible earlier bills. The approval letter confirms your category and expiration when categories overlap.
  • Dartmouth’s policy lists a 60-day appeal period and a 30-day complete-application decision goal. Its webpage lists 30 days to appeal and 30–45 days for a decision. The counselor can check your denial letter and confirm the deadline in writing; the longer published period is not a safe assumption.
Good to know

A payment plan changes when you pay. Financial assistance can change the amount you owe.

Other details
  • New Hampshire’s uninsured-patient hospital price cap is separate from financial assistance. The state hospital-billing card explains that protection.
Official sources
Ask your social worker

“Could the hospital reduce these bills even with our insurance, and can you help us check the policy and application?”

Why I’m asking: I want to know the amount we actually owe after insurance and hospital assistance.

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.

  1. Call the financial counselor and say “financial assistance policy”.
  2. Ask which providers are covered by it.
  3. 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.

HospitalFree care up toDiscounts up toInsured familiesFinancial counselor
Dartmouth Hitchcock Medical Center · policy250% FPL400% FPLyes844-808-0730

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

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