Health & Benefits

What is the Fair Patient Billing Act?

The way some hospitals have collected their bills in the past has led to a lot of complaints and lawsuits. Illinois responded by passing the Fair Patient Billing Act (the Act), which went into effect in 2007, to make sure that hospitals use fair billing and collection methods. The Act gives patients certain rights and makes hospitals meet specific requirements. The Act has been updated from time to time. The most recent changes became effective in July, 2024. Other Illinois laws, such as the Hospital Uninsured Patient Discount Act (HUPD), offer additional protections, some of which are described in this article.

Does the Fair Patient Billing Act apply to all hospitals?

No. It does not apply to hospitals that offer free medical services.

It does apply to all other hospitals licensed to receive patients and perform medical services for a fee in Illinois.

What responsibilities do hospitals have under the Fair Patient Billing Act?

Any hospital bill that you receive must include:

• The dates of services you are being billed for,
• A short description of the services,
• The amount you owe,
• Information on how to contact the hospital if you have questions about your bill, and
• Notice that you can get an itemized (more detailed) bill.

For patients who don't have insurance, the bill must also have information on how you can apply for financial assistance (charity care). This applies regardless of immigration status.

What is financial assistance for medical bills?

Non-profit hospitals are not required to pay state or federal taxes. In return, hospitals are required to provide free treatment to low-income patients or to reduce the bill for patients with incomes slightly above the low-income limit. Financial assistance is available to the patient at any time after treatment. Most hospitals use a form application and require that patients show documents to verify their financial situation.

What if my insurance plan doesn't cover some doctors?

When you are admitted to the hospital, or soon after, the hospital must provide you with written notice that:

• You may receive separate bills for services of health care professionals,
• Some hospital staff members taking care of you may not be covered to the same extent as the hospital under a particular insurance plan (if that is true),
• You may have to pay more for any services provided by staff members not covered by your insurance (if that is true), and
• Questions about your insurance coverage or benefit levels should be directed to your insurance company and not to the hospital.

What are my responsibilities as a patient?

To receive the protections of this Act, you must do your best to provide the hospital with the information they request as well as any other documents they may need to determine whether or not you qualify for a public health insurance program, financial assistance, or a payment plan. You must provide this information within 30 days of the hospital's request.

If there is a significant change in your financial situation that may affect a payment plan or your qualification for financial assistance, you must notify the hospital within 30 days of the change.

What if I have questions about the bill?

Under the Fair Patient Billing Act, all hospitals must provide a way for you to ask questions about your bill or challenge your bill if you think the charges are wrong. They can use:

• A toll-free telephone number,
• An address where you can mail your questions,
• A department within the hospital or a hospital employee that handles billing matters, as long as they give you appropriate contact information for that department or employee,
• A website, or
• An e-mail address.

Also, your bill must include a telephone number where you can ask questions about the bill. You can also use this telephone number to challenge the bill if you think any part of it is wrong.

How long does the hospital have to respond?

If you contact the hospital by phone, they must respond to you no later than 2 business days from the date of your phone call.

If you contact the hospital by mail, they must respond to you no later than 10 business days from the date they receive your letter. A "business day" means a day when the hospital's billing office is open.

Uninsured patients

What if I don't have health insurance?

If you don't have insurance, the hospital cannot try to collect payment from you until you've had the opportunity to:

• Review the bill to make sure it is correct;
• Apply to the hospital for financial assistance; and
• Get a reasonable payment plan.

Hospitals will need to check to see if patients without insurance can get help through public health insurance or the hospital itself. Before a hospital tries to get money through a collection action, they must follow the Act's rules that require this type of screening. Starting on January 1, 2025, if you are found eligible for public health insurance, the hospital must give you information about how to apply for the insurance program. 

Some hospitals may offer financial assistance to uninsured patients only if the patient first applies for coverage under a public health insurance program. In those cases, if an uninsured patient does not want to apply for public health insurance because of immigration-related concerns, the hospital can tell them about free resources to help with their concerns and potentially help with getting covered under a public health insurance program. The hospital can also use its standard screening process in these cases. 

Can I get a payment plan?

Yes. If you cannot pay a bill in one payment, the hospital must offer you a reasonable payment plan. A "reasonable" payment plan means one that takes into consideration your income and assets, the amount owed, and past payments. 

Financial assistance for uninsured patients

Certain hospitals must provide financial assistance to uninsured patients who meet specified income requirements and request a discount. You can get a discount on necessary services over $150. If you meet the requirements for a discount, the maximum that can be collected in a 12-month period is 20% of your income. You can apply for a discount within 90 days of the date of: 

• Discharge,
• Service,
• Completion of the hospital screening process described above, or
• Denial to a public health insurance program. 

If the hospital determines through its screening process that your income qualifies you for free care under the HUPD, then instead of sending you a bill, the hospital should give you information about how to apply for public health insurance. 

The hospital's financial assistance application must tell you to contact the hospital's financial counseling department with any questions or concerns. They also must give you that department's contact information. The application must also give you notice about your right to report complaints or concerns about the hospital's discount application or financial assistance process to the Health Care Bureau of the Illinois Attorney General. The application should include information about how to contact the Attorney General's office. 

How long do I have to apply for financial assistance?

The hospital must give you at least 90 days from the day you are released from the hospital or received outpatient care to apply for financial assistance. But, there is no time limit on applying for financial assistance. If your income is above federal poverty levels, the hospital may reduce your bill and discuss a payment plan with you. Once you have worked out a payment plan with the hospital, you are responsible for making the payments you agreed to. If you fail to make a decided payment amount, the hospital can take collection action against you.

What can I do if my application for financial assistance is denied?

After going through the required screening process with the hospital, if you apply for a public health insurance program and your application is denied, the hospital is allowed to take collection action against you. You can still attempt to work out a payment plan with the hospital.

What if I cannot afford to pay the bill?

If you have shown that you do not have the income or assets to pay the amount owed, and you have met your responsibilities under the Act, then the hospital cannot take legal action against you to collect the bill.

Insured Patients

Can I get a payment plan for my bill?

Yes. The hospital must give you 90 days, following the date of the first bill, to ask for a reasonable payment plan. The hospital cannot provide your bill to a collection agency or attorney before the 90 days are up. 

If you request a payment plan but cannot agree with the hospital on a reasonable payment plan within 90 days, then the hospital can start a collection action against you.

Survivors of Sexual Assault

Hospitals cannot directly bill sexual assault survivors for outpatient services related to the sexual assault. This is because of the Sexual Assault Survivors Emergency Treatment Act ("SASETA"). Outpatient services include: 

• Hospital emergency services,
• Forensic services,
• Transportation,
• Follow-up healthcare, and
• Medication. 

Hospitals can still bill for inpatient services.

Hospitals must send written notices to sexual assault survivors explaining that they will not be billed for outpatient services, but will be charged for inpatient services. 

If the hospital sends a bill anyway, you should notify the hospital and the Office of the Illinois Attorney General, Crime Victim Services Division. This can be done by calling the phone numbers listed in the written notice.

Note: The written notice requirement does not apply to hospitals that transfer sexual assault survivors to other hospitals after they provide appropriate medical screenings, examination, and necessary stabilizing treatments. 

Where to Go for Help

If you think that your rights have been violated, then you should talk to a lawyer right away. Click Get Legal Help above to get help finding a lawyer.

You can also file a complaint with the Office of the Illinois Attorney General.