Lien on Me"
The attack on homeownership by the Yale-New Haven
Health System and the
Yale School of Medicine
Yale-New Haven Hospital's Charity Care and
Coming to a
Town Near You?
Charity and Collections
at Bridgeport Hospital
Know Your Rights About
can I get financial assistance for my hospital bill?
What can I do about debt collectors?
What do I do if the hospital sues me?
What happens in the hospital wins a lawsuit against me?
If you are having
trouble paying a hospital bill or face a collections lawsuit, you have
rights that can keep you out of catastrophic debt. In these pages you
can learn the basics on where to look for financial assistance and how
to defend yourself from aggressive collections practices. In addition
to describing existing protections and programs, this pamphlet has the
first user-friendly explanations of the new protections for Connecticut
hospital patients that go into effect on October 1, 2003 under Public
Act 03-266: An Act Concerning Hospital Billing Practices.
These laws can help keep our community hospitals accountable to their
charitable missions. No one deserves a lifetime of debt and financial
disaster for the crime of getting sick or injured!
This summary of the
law is only for basic awareness of the rights of hospital patients and
people who may become financially responsible for hospital care. It is
no substitute for advice from a qualified lawyer, which should be obtained
whenever possible in a specific situation where hospital charges are being
made. For information on free legal assistance, call Connecticut Statewide
Legal Services: 800-453-3320.
can I get financial assistance for my
There are a number of government health insurance programs, including
Medicaid/Title 19 and State Administered General Assistance/SAGA (state
programs for patients who are low-income, disabled, pregnant etc), HUSKY
(the state program for uninsured children and teenagers), Medicare (for
the disabled or elderly), and Tricare/CHAMPUS (military and family members).
If you were uninsured at the time of your hospital visit, you may be able
to get your hospital bill covered retroactively if you enroll within 3
months. To learn whether you might be eligible and for free help applying
for these programs, call Student Health Outreach (SHOUT), a New Haven-based
non-profit organization: 203-777-9540 or toll free, 877-24-SHOUT. You
can also get information by calling United Ways Infoline: 2-11.
Hospital free care
Almost all Connecticut hospitals are non-profit and required to provide
some free care or charity care to patients who
cant afford their bills. Contact your hospitals social services
or billing office for eligibility information and an application. Make
sure to follow up after filing an application to make sure the hospital
received all necessary information. If you are rejected but are in serious
need of assistance, try to appeal the rejection and speak to a supervisor.
If you are having difficulty finding information about free care at your
hospital, or to receive free help filling out an application, call Student
Health Outreach (SHOUT): 203-777-9540, or toll free, 877-24-SHOUT.
Free bed funds
In addition to free care programs, most Connecticut hospitals also have
free bed funds, special donations they received to provide
free care to patients who cant pay for all or part of their hospital
stay (including insurance co-payments and deductibles). Connecticut law
(Sec. 19a-509b) requires hospitals to: post signs about the funds, in
English and Spanish; train admitting staff, billing staff, collection
agencies and attorneys to give you information about the funds and give
you an application; and, as of October 1, 2003, include information about
free bed funds and other free care programs in all bills and collection
notices sent to you.
The law gives you
the right to apply, and if you are rejected, reapply, for free bed funds
at any point in the billing or collection process. You should be able
to apply for free bed funds regardless of your immigration status, since
the donors of these funds did not limit them to citizens or documented
immigrants. The hospital must give you a written notice and explanation
of your rejection or acceptance.
Also, as of October
1, 2003, a hospital with free bed funds is prohibited from suing you for
a bill unless it determines you are not eligible for the free bed funds.
If your hospital is not following these steps, call the Connecticut Attorney
Generals Charity Division: 860-808-5020. For free help applying
for free bed funds, call Student Health Outreach (SHOUT): 203-777-9540
Some churches have
free bed funds in their names and can nominate patients to receive funds,
even if they dont meet the hospitals income requirements.
The church can also demand that its free bed funds be used to cover charges
related to your hospital stay but not billed directly by the hospital,
such as doctor fees. If you belong to a church, ask your church leader
about help with your hospital bill.
The actual cost of hospital services is usually much less than the list
price or gross charge hospitals bill to uninsured patientsoften
just half as much. Connecticut law (Section 19a-673) states that hospitals
cannot collect more than the cost of services from certain low-income
uninsured patients. You qualify as uninsured under
the law and should receive this major discount if:
1) Your income is at or below 250% of the federal poverty income guidelines
(see table, below);
2) You applied to and were rejected from SAGA and Medicaid because your
income was too high, and you arent eligible for Medicare or Tricare/CHAMPUS;
3) You are not eligible for coverage under any other government assistance,
private health plan, or awards to cover your injury from workers
compensation or a lawsuit.
Poverty Income Guidelines, 2003
of Poverty Level
This law applies even
if the hospital has already obtained a court judgment against you. Also,
as of October 1, 2003, the hospital is prohibited from suing you for the
bill until it has determined whether you qualify for the discount. The
hospitals collectors must provide you with written notice and explanation
of whether you qualify before the hospital can sue. If you think you qualify
for but are not receiving this discount, contact the hospitals billing
department or the Connecticut Attorney General Insurance Advocacy Department:
Setting up a payment
plan and negotiating a discount
If you dont qualify for the above types of financial assistance,
but still have a hospital debt that is too difficult pay off all at once,
ask your hospital billing office about setting up a payment plan. Also
ask for a discount on your bill. Hospitals bill uninsured patients at
the full gross charge, the sticker price for its services,
far more than what it cost to treat you. At the same time, hospitals give
most insurance companies discounts of as much as 30-60% off the gross
charge. Connecticut law currently only guarantees discounts for uninsured
patients below 250% of the federal poverty line (see above). But, hospitals
have the choice to voluntarily discount your bill. Tell the hospital:
better to discount your bill than to leave you with a debt that could
drive you into bankruptcy.
collectors are harassing me. What can I do?
provide information on your debt
Collectors in Connecticut are required to send you a letter stating the
amount you owe, the name of the creditor (hospital or doctor), where to
write to dispute the bill, and information on how to apply for free care
at the hospital.
stop if you are eligible for free care or are
covered by Medicaid/insurance
As of October 1, 2003, Connecticut law (Public Act 03-266) prohibits your
hospital from sending collection agencies or attorneys after you unless
it has found that you dont qualify for free bed funds and has determined
whether you qualify for the Connecticut Uninsured Patient Discount (see
Also after October
1, 2003, hospital collectors must stop contacting you if they find
information showing that you may qualify for free bed funds, other hospital
free care programs or any other program that could reduce your debt
(such as Medicaid, other government programs or commercial insurance).
Tell the collector in writing if: a) you think you are eligible for free
care, free bed funds or the Connecticut Uninsured Patient Discount; b)
your hospital visit was covered by government or private insurance; or
c) your insurance has now agreed to cover the claim. Include proof with
your letter, such as tax returns to prove your income, or letters from
your insurance company. The collector will have to wait for the hospital
to make a determination on your case before it can continue pursuing you.
If the collector does not stop, contact the Attorney General Fraud Division:
How to stop abusive
The Fair Debt Collection Practices Act, a federal law, prohibits collection
agencies and attorneys from lying to you, intimidating you, calling at
unreasonable times, or calling at work if you tell them not to. If a collector
is harassing you, get their name and address, and send a letter stating
that they should stop contacting you and any further contact will be reported
to the Federal Trade Commission. If they continue to harass you, file
a complaint with the Federal Trade Commission: 877-FTC-HELP or on the
web at www.ftc.gov. For more advice on how to deal with abusive collectors,
call Connecticut Statewide Legal Services: 800-453-3320.
do I do if the hospital sues me for my bill?
If you can, consult
a lawyer, especially if you are sued in Superior Court (civil court).
Contact Statewide Legal Services (800-453-3320) for information on obtaining
free legal advice or representation. If you cant get a lawyer, or
cant get a lawyer right away, below are some guidelines to follow
so you can claim your rights.
When and who hospitals
The hospital can sue you if you do not pay your bill, but only after it
has found that you are ineligible for free bed funds and has determined
whether you qualify for the Connecticut Uninsured Patient Discount (see
above). Hospitals must make these determinations for deceased patients
before they can sue those patients estates for a debt. In Connecticut,
hospitals can sue spouses for one anothers medical debts (unless
you are legally separated), and can sue both parents for the care of a
minor child (even non-custodial parents). A hospital cannot sue you for
the debt of a child 18 or older at the time of treatment or for the debt
of other relatives, unless you signed a contract (guarantor agreement)
binding you to be liable for their debt.
Filing an appearance
Do not ignore notice of a lawsuit. Otherwise, the hospital can win a judgment
against you by default (automatically). File an Appearance
form in the court clerks office before the Return Date
on your notice. If you dont meet that deadline, the hospital can
win the lawsuit by default. The address of the court clerks office
should be on the notice of the lawsuit. Court clerks can offer advice
on filling out paperwork, and can instruct you on how to apply to waive
court fees usually charged for filing documents.
After filing an Appearance, you should bring to the court clerks
office a written defense, your Answer in response to the hospitals
Complaint, within 30 days after the Return Date. The hospital
may win by default if you dont submit an Answer in time. Your Answer
should state your name, the date, the court docket number, and the legal
reasons why the plaintiff (the hospital) should not win its demand. List
all defenses that apply to your personal situation in your Answer. The
following are possible defenses:
- Plaintiff violated
the law on free bed funds, Sec. 19a-509b. This defense applies if the
hospital didnt inform you of the availability of free bed funds
(in English and Spanish), didnt include notice in all bills and
collection notices sent to you of the availability of free bed funds
and other free care programs, and/or didnt allow you to re-apply
for the funds.
- Plaintiff failed
to determine insurance status under Sec. 19a-673 or eligibility for
free bed funds before filing the collection lawsuit, as required by
Public Act 03-266. This defense applies if the hospital sent a collection
agency after you and/or sued you over your hospital bill before determining:
a) your eligibility for the Connecticut Uninsured Patient Discount and
b) that you didnt qualify for free bed funds. If you use this
defense, the hospital will have to prove in court that it gave you written
notice of both determinations before it sued you.
- Plaintiff didnt
offer uninsured discount under Sec. 19a-673. This defense applies if
you are eligible for the Connecticut Uninsured Patient Discount and
the hospital is trying to collect the full price and/or is overcharging
you due to a billing error.
- Medicaid balance
billing. This defense applies if the hospital sued you for a bill when
you were a Medicaid recipient at the time of your hospital visit or
you received retroactive Medicaid coverage after the hospital visit.
It is illegal for a hospital to sue a patient for a bill covered by
- Equitable estoppel.
This defense may apply if something a hospital employee said or did
led you to do something that changed your debt situation for the worse.
For example, you chose to undergo hospital treatment because a hospital
employee led you to believe that you qualified for financial assistance,
but afterwards you did not qualify.
- Immunity from ex-spouses
debt under Connecticut General Statute 46b-37. This defense applies
if you are being held liable for a debt your former husband or wife
acquired at a time when you were legally separated, unless you agreed
to pay for your former spouses medical care in your divorce settlement.
happens if the hospital wins a lawsuit against me?
If the hospital wins a judgment against you, the judge will order you
to make weekly or monthly payments. If the court-ordered payment is too
high, or becomes too high because of a loss of income, you can ask to
have it reduced by filing a claim for modification form through
the court clerks office. Whether you are charged interest is up
to the judge, so ask the judge to waive interest. As of October 1, 2003,
the maximum interest on hospital debt is 5% per year.
Be cautious about
signing a stipulated agreement with the hospitals lawyers,
because they may ask you to agree to payments and interest charges that
are higher than what the judge would order, and you will unable to appeal
this payment rate if you suffer a loss of income. Stipulated agreements
are the same as a judgment in the courts eyes, and will allow the
hospital to place a lien on your home and, if you miss payments, to garnish
your pay or bank account.
aggressive post-judgment collections tactics
Unfortunately, if you or your spouse own a home, the hospital can place
a lien on it at any time after receiving a judgment. Also, if you do not
follow the court-ordered payment plan, the hospital may try to garnish
up to 25% of your or your spouses wages, drain (execute)
your bank account(s), foreclose on your property, and hold a court hearing
to examine your assets. As of October 1, 2003, the hospital
can only do this if you miss weekly payments and the judge makes a special
determination that you are in default. This is why you should file a claim
for modification through the court clerks office to lower
the payment if it is unaffordable, or if you suddenly become unemployed
or sick and have to miss payments.
You have additional
rights if the hospital seeks an execution of your wages, bank accounts
- The hospital cannot
garnish your pay so that you take home less than the weekly minimum
wage (40 times the Connecticut hourly minimum wage, currently $276/week,
$284/week starting Jan. 1, 2004). If you normally earn less than the
weekly minimum wage-often the case for part-time workers-the hospital
cannot attach your pay. If you earn more than the weekly minimum wage,
the hospital can garnish your wages up to a maximum of 25% of your take-home
- You can petition
the court at any time to lower a wage attachment if you cant afford
the deduction. Ask to pay what you can afford (such as $10 per week
if you are having major financial difficulties) and explain why you
need the deduction. You can find the necessary form in the court clerks
- The first $1,000
in your bank account is exempt from a bank execution. So are any additional
savings from welfare, social security, unemployment compensation, court
approved child support, or workers compensation. The execution
notice will include a form that you must fill out and return to the
court by the indicated deadline in order to claim any of these exemptions,
but you must do so within 20 days after receiving the notice. Instructions
are listed on the back of the form.
- If the hospital
obtains a foreclosure on your home, you are entitled to keep the first
$125,000 of your homes value over the amount of any mortgages
or tax liens (under the homestead exemption).
Visit the court clerks office to file forms to lower a wage attachment
or claim an exemption.
Your rights if
you are eligible for free care or free bed funds
If you were rejected for the hospitals free bed funds in the past
because your income was too high, but your financial situation has changed
(loss of income, illness or injury, unemployment, increase in family size),
you have the right to apply again at any time for free bed funds, even
if the hospital has won a court judgment against you.
Also, as of October
1, 2003, the hospitals attorneys are required by law to stop collection
activity if they receive information that you qualify for free care or
free bed funds, even if the hospital already has a judgment against you.
This applies if you never had the chance to apply for free bed funds before,
or if your application was rejected before but your financial situation
has changed (loss of income, illness or injury, unemployment, increase
in family size). If the hospital receives proof that you are eligible
for hospital free care, its attorneys must stop garnishing your wages,
take all liens off your property, withdraw any pending bank execution.
They must wait for the hospital to make a determination before such collections
If you believe you
may qualify for free care or free bed funds, write to the collection attorneys
and the court clerk. Include copies of documents proving your financial
circumstances, such as pay stubs, tax returns, or a letter from your employer
or doctor. Then contact the hospital billing office about filing a free
care application. If the hospital attorneys do not stop collecting, contact
the Attorney General Fraud Division: 860-808-5355.
Government medical assistance programs
Department of Social Services (Medicaid, SAGA and HUSKY): 800-842-1508
HUSKY hotline: 877-CT-HUSKY or www.huskyhealth.com
Social Security Administration (Medicare): 800-772-1213 or www.ssa.gov
TriCare/CHAMPUS (Military): 888-999-5195 or www.tricare.osd.mil
Help with medical
assistance or hospital free care applications
Student Health Outreach: 203-777-9540 or 877-24-SHOUT or
United Way Infoline: 2-11 or www.infoline.org
Charities Division (problems accessing free bed funds): 860-808-5020
Fraud Division/Insurance Advocacy Department (billing fraud): 860-808-5355
harassment by collection agencies or lawyers
Federal Trade Commission: 877-FTC-HELP or www.ftc.gov
bill review services (to find overcharging)
Edward R. Waxman & Associates (bills of $5,000 or more): 877-679-7224
American Medical Bill Review: 530-221-4759 or www.ambr.com
Medical Billing Advocates of America: 540-387-5870 or
State of Connecticut Insurance Department Consumer Affairs Division: 800-203-3447
The Center for Medicare Advocacy: 860-456-7790 or
Connecticut Statewide Legal Services: 800-453-3320 or
New Haven Legal Assistance: 203-946-4811 or www.nhlegal.org
Jerome N. Frank Legal Services Organization at the Yale Law School:
Experian: 888-397-3742 or www.experian.com
Equifax: 800-685-1111 or www.equifax.com
TransUnion: 800-888-4213 or www.transunion.com
Unfair debt collection
by Yale-New Haven Hospital, Bridgeport Hospital or Yale School of Medicine
Hospital Debt Justice Project: 800-478-0635 or www.ctneweconomy.org/hospdebt.html
This handbook was researched and written by Dana Pierce (AFL-CIO Legal
Summer Intern, Boston University Law School) and Grace Rollins (research
analyst for District 1199/SEIU, also author of Uncharitable Care: Yale-New
Haven Hospitals credit and collection practices, available at www.ctneweconomy.org),
with assistance from Sheldon Toubman (New Haven Legal Assistance), Ellen
Andrews (Connecticut Health Policy Project) Irene Liu (Advanced Strategies
for Health Access/Student Health Outreach), and the Jerome N. Frank Legal
Services Organization at the Yale School of Law.
The Connecticut Center
for a New Economy (CCNE) is a non-profit organization in New Haven, CT
dedicated to improving the economic and social well-being of working families
in Connecticuts urban centers by initiating and supporting efforts
to raise wages of the working poor, improve public education and training,
expand access to affordable healthcare and preserve affordable housing.
For more information, visit
www.ctneweconomy.org or call 203-785-9494.
The New England Health
Care Employees Union, District 1199 is a local of the Service Employees
International Union (SEIU), the largest healthcare workers union in the
U.S. and a leading voice for healthcare reform: standing up for a system
that puts patients first and gives healthcare workers the support to provide
quality care. For more information, visit www.seiu.org or call 202-898-3200.
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you suffer from unfair debt or collection practices from Y-NH Hospital,
Yale School of Medicine, Yale Diagnostic Radiology or Bridgeport
call 203 777-9880
or 800 478-0635
to share your story.