Published by the Modern Lending Solutions editorial team. Last reviewed: .

Short answer: before you borrow to pay a hospital bill, ask the hospital for its financial assistance policy, its application and its plain language summary, and apply. A nonprofit hospital must make these available for free, must tell you about assistance before certain collection actions, and must refund what you overpaid if you qualify later. If the bill is a surprise out-of-network charge, or much higher than an estimate you got, the No Surprises Act may help.

The medical bills guide covers who qualifies, the 240-day application period, payment plans and medical credit cards, and compares their costs. This guide covers the steps around the application.

Step 1: get the policy, the application and the summary

A nonprofit hospital must post its financial assistance policy, its application form and a plain language summary of the policy on a website, and must give paper copies on request and without charge, by mail and in the emergency room and admissions areas (IRS). It must offer the summary at intake or discharge and put a notice about assistance on billing statements (IRS). The policy must also list which other providers delivering care in the hospital are covered by it and which are not (IRS), so check whether a separate doctor's bill is included.

Step 2: know what must happen before collection actions

  • Before extraordinary collection actions, the hospital must send a written notice that financial assistance is available, naming the actions it intends to take and a deadline at least 30 days later, with the plain language summary (IRS).
  • It must also make a reasonable effort to tell you orally about the policy and how to get help applying, at least 30 days before the first such action (IRS).
  • Once you submit a complete application during the application period, the hospital must suspend those actions, decide whether you qualify and tell you in writing why (IRS).
  • The hospital may keep accepting applications at any time (IRS). If you missed a date, ask anyway.

Step 3: if you qualify after you paid

If you qualify, the hospital must refund what you paid above the amount you owe as an eligible patient, unless the excess is less than $5, and must take reasonably available measures to reverse collection actions, including removing adverse information it reported to a credit bureau (IRS). If you qualify for free care, it must tell you in writing that nothing more is owed.

Example: you paid $1,000.00 on a bill, and the hospital later finds you eligible and says you owe $400.00 for that care. The excess, $1,000.00 - $400.00 = $600.00, is refundable. This is why it can pay to apply before you put the bill on a loan or a card.

No Surprises Act basics

  • If you use health insurance, the No Surprises Act protects you from unexpected out-of-network bills for emergency room visits, for non-emergency care related to a visit to an in-network hospital, hospital outpatient department or ambulatory surgical center, and for air ambulance services (CMS).
  • If you do not have or use insurance, CMS says providers usually must give you a good faith estimate when you schedule care at least 3 business days ahead or ask for one, and you may be able to dispute a bill that is at least $400 more than the estimate (CMS).
  • CMS takes questions and complaints at 1-800-985-3059 (CMS).

Medical debt on credit reports

In January 2025 the CFPB issued a rule to keep most medical debt out of credit decisions. On July 11, 2025, a federal court in Texas vacated that rule (CFPB), so it does not apply. Check your report before you apply for credit (how to check your credit report), and if a medical debt is listed wrongly, for example one the hospital agreed to forgive, see how to dispute a reporting error.

Questions to ask the billing office

  • Can you send me the financial assistance policy, the application and the plain language summary?
  • Is this hospital covered by a financial assistance policy, and are the doctors who treated me covered too?
  • Can I have an itemized bill?
  • Will you hold collection while my application is reviewed?

This guide explains federal rules in general terms. It is not legal advice.

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Sources

  1. IRS: Financial Assistance Policies (FAPs), section 501(r)(4) (updated December 28, 2025)
  2. IRS: Billing and Collections, section 501(r)(6) (updated July 2, 2026)
  3. CMS: Medical bill rights (No Surprises Act)
  4. CFPB: Prohibition on Creditors and Consumer Reporting Agencies Concerning Medical Information (Regulation V), final rule page with the July 11, 2025 vacatur

Disclosure: Modern Lending Solutions is not a lender, loan broker or agent for any lender or loan broker, and does not make credit decisions. Any compensation we receive is paid by participating lenders, only for advertising services. This guide is general information, not financial or legal advice.