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

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Federal, exists in every state

Help reducing hospital bills (financial assistance)

A hospital’s written financial-assistance policy can reduce bills, including some amounts left after insurance.

What it is

A hospital’s written financial-assistance policy can reduce bills, including some amounts left after insurance.

Hospital assistance may help even when your child has insurance. Your social worker can obtain the current policy and check which hospital and clinician bills it covers. The financial counselor can explain any hardship review before estimating a reduction.

Policy rules
  • Your treating hospital’s current policy decides its income and asset tests. The financial counselor can explain which assets and bills enter the calculation. A policy from another hospital does not decide your bill.
  • The financial counselor can explain whether a hardship review is available beyond ordinary income limits. Any discount depends on the hospital’s policy and your circumstances.
  • The financial counselor confirms the policy’s effective date, approval duration, covered facilities and separately billed clinicians. The counselor can also identify the hospital’s legal entity and tax-exempt status. At Sanford, a policy marked reviewed or revised May 5, 2026 still needs its effective terms confirmed. A review date alone does not establish when a policy applies.
What you get
  • A reduction or write-off of eligible hospital bills.
  • A review of any hardship option in the hospital’s policy.
Federal protections
  • At a tax-exempt hospital, the federal application period lasts at least 240 days after the first post-discharge bill.
  • At an applicable tax-exempt hospital, extraordinary collection actions cannot begin for at least 120 days after that bill. A timely complete assistance application pauses those actions while the hospital decides. This does not mean every bill or reminder stops.
  • Under the applicable tax-exempt-hospital rules, approval can require a refund of payments above the assistance amount when the excess is $5 or more.
If you decide to apply
  1. Ask your treating hospital’s financial counselor for its current policy, application and list of covered doctors.
  2. Have income records, bills, insurance statements and account information ready.
  3. Ask which collection activity will pause during review and request the answer in writing.

Your treating hospital’s financial-assistance office · Official page ↗

Good to know

Doctors who bill separately may fall outside the policy. County poor relief is a separate application and may involve repayment.

Official sources
Ask your social worker

“What could hospital assistance cover, what bills would remain, and could you help us apply if it fits?”

Why I’m asking: I want to understand the correct balance before agreeing to payments.

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
Sanford Children's Hospital Sioux Falls · policyunknownunknownunknown877-629-2999

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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