Money & Debt

Medical debt is money owed for health care services, products, or devices. The term usually refers to health care bills that were not paid in full by the due date.

Medical debt may include:

• Charges for services provided,
• Costs not covered by insurance, and
• Bills from different providers involved in care.

A single medical visit may result in multiple bills. For example:

• Separate bills from a hospital, doctor, lab, or other providers,
• Different rates depending on whether a provider is in-network or out-of-network, and
• Different payment terms for each bill.

Under Illinois law, consumer credit reports cannot include medical debt. However, if a medical bill is paid using a credit card or loan, the credit card or loan balance is no longer treated as medical debt for credit reporting purposes. These rules are in section 2EEEE of the Illinois Consumer Fraud and Deceptive Business Practices Act.

Yes, a hospital can bill a patient for emergency care. The right to receive emergency care does not depend on the ability to pay.

A hospital must provide emergency services without requiring payment first. After treatment, the hospital may send a bill for the services provided.

State and federal laws may limit how much can be charged or collected for emergency care. For example:

• The No Surprises Act limits charges for certain emergency services, and
• Illinois law requires hospitals to review eligibility for financial assistance before collection in some cases.

Even when a bill is issued, patients may have rights related to insurance coverage, financial assistance, or payment plans.

The Fair Patient Billing Act is an Illinois law that sets rules for how hospitals bill and collect payment from patients. It requires hospitals to use fair billing and collection practices.

The law gives patients certain rights and requires hospitals to follow steps before trying to collect payment. These include:

• Providing clear and detailed bills,
• Offering a way to ask questions or challenge charges, and
• Screening patients for financial assistance before collection in some cases.

Hospitals must also give information about financial assistance programs, especially for patients without insurance.

The law applies to hospitals in Illinois that charge for medical services. It does not apply to hospitals that provide all services free of charge. 

Hospital bills in Illinois must explain what is being charged and how to ask questions or request more details. This includes:

• The dates of service,
• A short description of the services,
• The total amount owed,
• Contact information for billing questions, and
• Notice that an itemized bill is available on request.

For patients without insurance, the bill must also include information about how to apply for financial assistance.

Medical bills often have three main pieces of information:

• A general description of services provided,
• The insurance coverage applied, and
• How much the patient is expected to pay.

Services: The services section may include service dates, descriptions, and charges. If the bill lacks sufficient detail or includes unfamiliar services, ask the provider for an itemized bill. Common problems with the services section include inaccurate or duplicate charges.

Insurance: The insurance section shows how the bill was processed. This may include:

• What the insurance plan paid, and
• The amount by which the bill was reduced or adjusted.

Contact the insurance plan with questions about how the claim was processed.

Patient responsibility: The patient typically owes any amount billed for services not covered by insurance. If the patient is unable to pay this amount, financial assistance may be available.

Hospitals and insurance companies have different roles in medical billing.

Hospitals send bills for the services provided. They list the care given, the charges, and the total amount owed. Hospitals assign billing codes to the services.

If there is a problem with the charges or services listed, contact the hospital. Ask for an itemized bill to verify the services and charges.

Hospitals do not decide what insurance covers. Coverage decisions are made by the insurance plan.

Insurance companies decide what they will pay. The insurance plan reviews the claim and determines:

• Which services are covered,
• How much will be paid, and
• What amount remains the patient’s responsibility.

This information may be included in an Explanation of Benefits (EOB).

If there is a problem with what is covered or paid, contact the insurance company.

Patients have the right to ask questions about a hospital bill and to challenge charges they believe are incorrect. Ask the provider for an itemized bill to review the charges in more detail. This may help identify errors or unexpected services. Watch out for "upcoding," which means billing for more complex or expensive services than were performed.

Hospitals must provide ways to ask questions, such as:

• A phone number,
• A mailing address,
• A billing department or staff contact,
• A website, or
• An email address.

Hospitals must respond to billing questions within specific time limits. These timelines depend on how the question is made:

• Phone requests, within 2 business days, and
• Written requests, within 10 business days after the hospital receives the request.

A business day for medical billing purposes is a day when the hospital’s billing office is open.

Financial assistance programs provide free care or reduced medical bills for patients who meet income requirements and request a discount. Nonprofit hospitals are required to offer financial assistance.

In Illinois, hospitals must provide information about financial assistance, especially to patients without insurance. Financial assistance may be available to:

• Patients without insurance, and
• Patients with limited income, including those with insurance.

Patients generally have at least 90 days to apply for financial assistance. This time period usually starts from the date of:

• Discharge from the hospital,
• Outpatient service,
• Completion of the hospital’s screening process, or
• Denial When a court rejects or refuses to allow a request; for example, when a judge decides not to grant an attorney's objection. of a public health insurance application.

Hospitals usually require an application and documents showing income, assets, Anything a person owns that has financial value and household size. Some hospitals may require patients without insurance to apply for public health insurance before receiving hospital financial assistance.

Hospitals must provide information about financial assistance regardless of immigration status. Other resources may be available for patients who do not apply for public health insurance.

Under Illinois law, hospitals must take certain steps before starting collection efforts against uninsured patients. This includes giving patients an opportunity to review the bill, apply for financial assistance, and provide information needed to determine eligibility. 

Patients are generally expected to cooperate with the hospital’s screening process by promptly submitting the required information and documents to verify their financial status. Hospitals may set deadlines for providing this information, often within 30 days of a request. Some hospitals may also require uninsured patients to apply for public health insurance before receiving hospital-based financial assistance.

Certain uninsured patients may qualify for discounts on hospital bills for necessary services over $150. If a patient qualifies, the total amount collected by the hospital over a 12-month period is generally limited to 20% of the patient’s income.

If an account has already been sent to collections before the patient applies for financial assistance:

• Tell the collector that a financial assistance application is pending, and
• Ask them to pause collections.

Yes, patients with health insurance have at least 90 days to request a payment plan before a hospital can send a bill to collections.

A reasonable payment plan considers:

• Income and assets, Anything a person owns that has financial value
• The amount owed, and
• Past payment history.

If a payment plan is agreed to, the patient is responsible for making the scheduled payments. If payments are missed, the hospital may begin collection actions.

Patients may receive separate bills from different providers involved in hospital care. Not all providers may be covered the same way by an insurance plan.

Hospitals must give written notice that:

• Separate bills may be issued by doctors or other health care professionals,
• Some providers may not be covered at the same level as the hospital, and
• Services from out-of-network providers may result in higher costs.

These notices help explain why multiple bills may be received for the same hospital visit. 

Yes, Medicaid may help pay for medical bills from up to 3 months before the application date. This is called retroactive Medicaid. Retroactive Medicaid may be available even if someone passed away before applying. 

To qualify, the person must have been eligible for Medicaid at the time the medical services were received. Eligibility is based on income, resources, and program rules. The assessment requires information for each of the last 3 months. Records going farther back may be needed in the event of certain Social Security appeals and redeterminations.

Apply through the Illinois Application for Benefits Eligibility (ABE) website.

Illinois law limits how hospitals can bill survivors of sexual assault. When a person commits an act of sexual penetration by force or threat of force. Done without the consent of the victim. This includes when the victim cannot give consent.

Hospitals cannot bill survivors directly for outpatient services Services that do not require staying overnight at a hospital related to a sexual assault. These services include:

• Emergency services,
• Forensic medical exams,
• Transportation related to care,
• Follow-up health care, and
• Medication.

Hospitals may still bill for inpatient services. Services that require a patient to stay at a hospital for one or more nights

The hospital that first provides the survivor with medical screening, examination, and stabilizing treatment must give a written notice explaining these billing protections. The notice must explain:

• Which services will not be billed to the patient, and
• Which services may still result in charges.

If a survivor is transferred after receiving initial screening and stabilizing care, the notice requirement does not apply to the receiving hospital.

Surprise or balance billing is a medical bill for an amount:

• Not covered by a health insurance plan, and
• Not limited by an agreement between the insurance plan and a provider.

Health insurance plans often have agreements with “in-network” providers. In-network providers are also called “participating providers” by some plans. These providers:

• Agree to accept a set amount for services, and
• Can only bill the patient for the difference between that amount and what the plan pays.

Providers who are not in the plan’s network are called “out-of-network” providers. Some plans call these providers “non-participating providers.” Out-of-network providers do not agree with the plan to limit their charges. This means bills may be higher than for in-network care.

Surprise or balance billing may happen when:

• A provider is out-of-network and the patient does not know,
• Services cannot be avoided, such as during an emergency.

No Surprises laws limit how much providers can charge for certain out-of-network medical services. They apply to many employer-sponsored plans, marketplace plans, and some individual plans. Medicare and Medicaid already limit these charges.

When medical care is covered by the No Surprises rules:

• Charges for emergency care providers who are out-of-network cannot be more than the amount charged for in-network care,
• Without prior written consent, When someone gives permission for someone else to do something certain non-emergency services provided by out-of-network providers at in-network facilities cannot cost more than the same services from in-network providers, and
• Some out-of-network providers at in-network facilities cannot send balance bills.

Health care providers and facilities must give a clear notice explaining:

• These billing protections,
• Who to contact with questions or complaints, and
• That written consent is required to waive To give up a legal right or pardon a fee these protections.

If a patient is uninsured, providers must usually give a good-faith estimate of expected charges before care.

Learn more about the No Surprises law by reading the Centers for Medicare & Medicaid Services (CMS) No Surprises Act resources. The Illinois rules are in the Illinois Insurance Code sections 215 ILCS 5/356z.3 (Disclosure of limited benefit) and 215 ILCS 5/356z.3a (Billing; emergency services; nonparticipating providers).

A Qualified Medicare Beneficiary A person that gets property or money from someone when they die (QMB) is a person enrolled in a Medicare program that limits out-of-pocket costs for covered services.

Under federal law, providers and debt collectors cannot collect cost-sharing amounts from a person with QMB status for covered Part A and Part B services.

This means:

• No copayments, coinsurance, or deductibles can be charged for covered services, and
• Any payments already made for covered services may have to be refunded.

If a bill or collection attempt is made for these costs, it may violate federal law. Tell the healthcare provider to correct the billing due to QMB status.

Use Get Legal Help to find free and low-cost legal resources. Visit Debt Help Illinois for help prioritizing and managing debt.

Many complaints can be resolved directly with a hospital. For surprise or balance billing issues, contact:

• The federal No Surprises Helpdesk at (800) 985-3059, and
• The Illinois Department of Insurance Office of Consumer Health Insurance at (877) 527-9431.

If a hospital or other medical provider violates laws related to how care is billed, file a complaint with the Office of the Illinois Attorney General. Call the Illinois Attorney General's Crime Victim Assistance Line at (800) 228-3368 for billing issues related to sexual assault. When a person commits an act of sexual penetration by force or threat of force. Done without the consent of the victim. This includes when the victim cannot give consent.