Tennessee program
Price limit on an uninsured hospital bill
Tennessee limits what a covered licensed facility can require an uninsured patient to pay.
What it is
Tennessee limits what a covered licensed facility can require an uninsured patient to pay.
An uninsured hospital bill can be different from the amount the facility may require you to pay. Tennessee’s law uses the facility’s cost rather than its opening charge. The hospital’s own financial assistance policy may offer additional help.
Eligibility rules
- The statute applies to an uninsured patient at a facility licensed under the covered chapter.
- The enacted effective date is July 1, 2007.
What you get
- An uninsured price ceiling of 175% of the facility’s cost, where the law applies.
- The facility’s published charity-care policy statement.
What the help covers
- The calculation uses the cost-to-charge ratio in the facility’s most recent joint annual report. It is not simply 175% of Medicare or a percentage discount from the bill.
- Ask the billing office in writing for the cost-based price the law requires. If it refuses, the hospital's licensing regulator takes complaints; the hospital's own assistance policy is a separate route.
If you decide to apply
- If you want a bill reviewed, the counselor can help request the cost calculation Tennessee law entitles you to.
- The counselor can also obtain the financial assistance policy and check the covered charges, doctors and application records.
Your hospital’s billing office or financial counselor. · Official page ↗
After you ask
- The billing office calculates the cost-based price and the financial counselor explains the hospital’s assistance process.
Good to know
The uninsured price cap is not a promise of free care. An insured family can ask about the hospital’s separate assistance policy.
Other details
- A qualifying assistance application can stop extraordinary collection actions under federal tax-exempt-hospital rules, but not necessarily ordinary billing contacts. Vanderbilt’s own policy provides broader protection. A requested broader hold needs written confirmation. Court papers have separate response deadlines; legal aid can check interest, reporting, liens, garnishment and lawsuits for the actual bill.
- A hospital assistance policy may not cover separately billed doctors. Each bill needs its own coverage check.
- Where federal section 501(r) applies, extraordinary collection actions generally cannot begin in the first 120 days after the first post-discharge statement. The assistance-application period lasts at least 240 days, with additional notice and application-review protections. The counselor must identify the legal billing entity and applicable rules.
- There is no federal ban on medical debt appearing on your credit report right now. A hospital cannot take more than a quarter of your take-home pay without a court judgment.
Related conversation: the separate hospital financial assistance card covers help beyond the uninsured price cap.
Official sources
“Does the uninsured cost-based limit apply to this bill, and could the hospital’s assistance policy reduce it further? Could you help us compare those routes and prepare any needed application?”
Why I’m asking: I want to understand the amount we actually owe and what assistance can reduce it.
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 in writing for the cost-based price and the charity-care policy, and keep every reply.
Your social worker
The financial counselor works out the figure and gives you the assistance application.
The care team
Records and letters when the application asks for them.
- Who decides
- The hospital billing office.
- Ask the billing office
- “My child was uninsured for this care. Tennessee law limits what you can require an uninsured patient to pay to 175 percent of your cost. Please send me that figure and your charity-care policy statement, and hold collections while I apply.”
How to apply
First step: Discuss the bill with the social worker or financial counselor before deciding how to handle it. Insurance, the uninsured cost-based limit and assistance may change the balance. A requested collection hold needs written confirmation; court papers have separate deadlines.
- Discuss the bill with the social worker or financial counselor before deciding how to handle it. Insurance, the uninsured cost-based limit and assistance may change the balance. A requested collection hold needs written confirmation; court papers have separate deadlines.
- Ask separately for the hospital’s financial assistance application, and ask for collections to be held while it is decided.
Official application / program page ↗
Where it starts: Write to the billing office asking for the cost-based price under the 2007 law and for the hospital’s charity-care policy statement.
What to gather
- Every bill and itemized statement
- Proof your child had no insurance on the dates of care
- Any letter about collections
How long: Courts have not recognized a private right of action under this price-cap section alone. Licensing-regulator and legal-aid review can help with a disputed bill. At a covered tax-exempt hospital, the federal assistance-application period lasts at least 240 days after the first post-discharge bill.
What a yes looks like
A revised bill worked out from the hospital’s own cost, and a copy of the charity-care policy.
What a no looks like, and the next move
If the hospital says the law does not apply to it, ask in writing which chapter it is licensed under, and keep that reply.
Watch out
- It caps the price; it is not a discount off the first quote. Ask for the cost-based figure in writing.
- The law is written for uninsured patients. If your child was insured, ask for financial assistance instead.
- Federal hospital protections depend on the legal billing entity and application process. Other state collection protections and court deadlines need individual legal review.
If they say no, quote this: Public Chapter 419 of 2007: a licensed facility is prohibited from requiring an uninsured patient to pay more than 175 percent of the cost of services, using the cost-to-charge ratio in its most recent joint annual report.
Dates that change this
2007-07-01: The enacted 2007 text was read. The current consolidated law and any later amendments could not be obtained, so treat this as the law as enacted and ask the billing office to confirm it applies. (not yet confirmed against the final rule)
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
An uninsured patient cannot be required to pay more than 175 percent of what the care cost the hospital.
- $175 — Ceiling on what an uninsured patient can be required to pay, as a share of the facility’s cost
Legal protection: Every licensed facility has to develop a concise statement of its charity-care policies · Under federal rules for charitable hospitals, 240 days from the first bill after discharge to apply for financial assistance, and 30 days’ written notice before certain collection actions
What it costs the family: None to ask.
The eligibility facts, as published
- Who
- an uninsured patient at a facility licensed under the chapter
- Basis
- 175 percent of the cost of the services, using the cost-to-charge ratio in the facility’s most recent joint annual report
- Effective
- 2007-07-01, as enacted
- Not established
- a statewide free-care income line, an enforcement route, collection timelines, and any medical-debt credit-reporting, interest, garnishment, lien or lawsuit limit
The trap: This is a cap on the price, not a discount off the price the hospital first quotes. Ask the billing office in writing to show you the cost-based figure and how it was worked out, and ask separately for financial assistance, which is a different conversation.
Where I read this
- Public Chapter 419 of 2007 — Tennessee General Assembly, read September 10, 2026
- Requirements for charitable hospitals under section 501(r) — Internal Revenue Service, read September 10, 2026
- Billing and collections, section 501(r)(6) — Internal Revenue Service, read September 10, 2026