Charity care & financial assistance
Sliding-scale discount at for-profit hospitals
Section 501(r) charity-care rules apply only to non-profit hospitals. But for-profit hospital systems — HCA, Tenet, Universal Health Services, Community Health Systems — typically have sliding-scale or self-pay discount policies of their own. They're set by corporate policy, not federal law, and patients usually have to ask.
Federal basis
No specific federal statute — corporate policy by hospital system
Hospital-specific Self-Pay Discount Policy / Financial Hardship Policy
Read the source →What this looks like in practice
For-profit hospital corporations have written self-pay discount policies that typically apply (1) automatic discounts to uninsured patients (often 30-60% off chargemaster), (2) sliding-scale discounts based on income, sometimes mirroring §501(r) thresholds, and (3) hardship grants in extreme cases. The policies aren't required to be publicly published the way §501(r) FAPs are, but each system's billing department can describe theirs.
The pattern that helps patients: ask specifically. "Does [hospital] have a self-pay discount or financial hardship policy?" and "Can I apply for it for this bill?" Most billing reps will guide the patient through the process. Many self-pay patients are eligible for substantial reductions but never ask.
How to spot it on a bill
- 01.Bill is from a for-profit hospital (HCA, Tenet, UHS, CHS, or local independent for-profit).
- 02.You're paying out of pocket (uninsured, high-deductible, or post-insurance balance).
- 03.You haven't yet asked about a discount program.
What to write — ready-to-paste language
Replace the bracketed fields with your specific details. Send by certified mail with return receipt, or via the hospital’s patient portal if it offers documented messaging. Keep a copy.
I'm writing about my balance of $[amount] on the bill dated [date]. I'd like to apply for [hospital]'s self-pay discount and/or financial hardship policy. Please (1) send me the written policy describing eligibility and discount levels, (2) provide an application, and (3) hold collections activity on this account during the application review. My household income is $[income] for a family of [size], which is approximately [N]% of the Federal Poverty Level. If charity care or sliding-scale options are available, I want to be considered for the discount that maximally reduces my balance.
This is a starting point, not legal advice. Your specific situation may warrant additional details. Our scan tool drafts this letter automatically with your bill’s specifics filled in.
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Related scenarios
Charity care — your right to financial assistance at non-profit hospitals
ACA §501(r) requires non-profit hospitals to offer free or discounted care to patients meeting income criteria. Most patients never apply because most never know.
Presumptive eligibility — automatic charity-care qualification
Some non-profit hospitals' Financial Assistance Policies grant automatic charity-care eligibility to certain categories of patients without requiring an income application.
Apply for Medicaid retroactively — covers up to 3 months back
Federal Medicaid rules allow retroactive coverage for up to 90 days before the application month. If your bill is from that window, Medicaid can pay it.
Common questions
Do for-profit hospitals legally have to offer financial assistance?
How do I find out which hospitals are non-profit vs. for-profit?
P.S. The dispute language above is a starting point. Bills with this pattern often have additional issues alongside it — coding errors stacked with markup, surprise bills stacked with charity- care eligibility. The scan finds all of them in one pass. Start the audit →
P.P.S.Federal law gives you these rights regardless of how the bill arrived. Insured, uninsured, in-network, out-of-network — the underlying patient-protection statutes apply.
P.P.P.S. Bills are time-sensitive. Most insurance appeals must be filed within 180 days. Charity-care discounts at non-profit hospitals are most easily applied within 240 days of the original bill. Acting earlier costs less.