Cut a hospital bill with a coding audit and charity care
A hospital balance reduced or wiped — an itemized bill with CPT/HCPCS codes obtained, duplicate and unbundled charges disputed in writing, a Section 501(r) financial assistance application filed with income proof, and a cash settlement negotiated against Medicare reference rates.
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Who it's for
Uninsured or underinsured U.S. patients holding a hospital balance over $1,000 after an ER visit, surgery, or inpatient stay — especially anyone who has seen a collections warning or faces a five-figure bill. The 501(r) protections apply to tax-exempt non-profit hospitals; if your hospital is for-profit, the audit and negotiation steps still work, but the federal charity care deadlines do not bind it.
About this playbook
This guide turns a five-figure hospital statement or a collections warning into a smaller, verified balance you can actually settle. You start by freezing the account, then obtain an itemized bill with CPT/HCPCS codes and the medical record for your stay. A line-by-line audit exposes duplicate, unbundled, and upcoded charges, which you dispute in writing with the audit attached. You then locate the hospital's 501(r) financial assistance policy — cross-checked against its IRS Form 990 Schedule H — extract the income threshold (typically 200%–400% of the federal poverty level), and file the charity care application with income proof. Whatever remains after the determination is negotiated against Medicare reference rates, using a settlement script anchored to Medicare plus 15%. It covers tax-exempt non-profit hospitals; it does not cover insurer appeals, Medicaid applications, or bankruptcy.
What you'll do, step by step
Free preview — these steps are open to read in full before you buy.
Phase 1: Freeze the account and assemble your paperwork
0/4Stop the account from reaching collections while you work, check where the debt currently stands, and gather the billing documents and income proof that every later phase depends on.
- 30 min
- 45 min
- 45 min
- 1 hour
Phase 2: Request the itemized bill and the medical record
4 stepsPhase 3: Audit every charge against the record and reference rates
5 stepsPhase 4: Apply for 501(r) charity care
5 stepsPhase 5: Negotiate the remainder at Medicare plus 15%
6 stepsDetails
What you need first
A current hospital statement or collection notice for the account, a printer and scanner or fax, your household income documentation (pay stubs, tax return, benefit award letters), your family size, and a hospital that is still inside its charity care application window — under 501(r) you have at least 240 days from the first post-discharge statement.
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About the creator
I write about budgeting, debt and getting money in order for people who want a plan, not a list of tips.
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