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Uninsured Personal Injury Claimant’s Afforded Benefits Under The ACA and California Law

January 31, 2017

As of December 31, 2014, under the Affordable Care Act Section 501(r) of the Internal Revenue Code, nonprofit hospitals have a social obligation to provide community benefits in exchange for favorable tax treatment. The purpose of many of these regulations is to ensure nonprofit hospitals are offering financial assistance to patients in need. Meisel Law Group is familiar with these requirements and committed to assist low income victims of injury.

California requires all hospitals (for profit and nonprofit), with few exceptions, to maintain written financial assistance policies. At a minimum, a patient is qualified for free or discounted care if he or she is 1) a self-pay patient or one with high medical costs, or 2) a patient with a family income that does not exceed 350 percent of the federal poverty level. Hospitals also may extend this to higher income earners. (Cal. Health & Safety Code § 127400.) Emergency Physicians also must provide discounts to uninsured patients or patients with high medical costs who are at or below 350 percent of the federal poverty level. (Cal. Health & Safety Code § 127450(b).) Most importantly these California hospitals may only charge patients eligible for financial assistance “the amount of payment the hospital would expect, in good faith, to receive for providing services from Medicare, Medi-Cal, the Healthy Families Program, or another government-sponsored health program of health benefits in which the hospital participates, whichever is greater.” (Cal. Health & Safety Code § 127405(B)(d).)

California hospitals must make a reasonable effort to determine a patient’s eligibility under their financial assistance policy prior to filing a lawsuit, prior to providing information to credit agencies, and prior to obtaining a debt collector. California hospitals must wait 150 days after initially billing a patient to report any negative information about a patient to consumer reporting agencies or commence an action in court.  (Cal. Health & Safety Code § 127425(d).)

Meisel Law Group urges you to hire a personal injury attorney with detailed knowledge about 501(r) and California’s Health & Safety Code for your personal injury case as this can make a substantial difference in the claimant’s net financial recovery.