Colorado Hospital Discounted Care

Hospital Discounted Care was created by House Bill (HB) 21-1198 which requires hospitals to screen all uninsured patients and any insured patients who request financial assistance for Health First Colorado (Colorado's Medicaid Program), Child Health Plan Plus (CHP+), Medicare, Emergency Medicaid, and financial assistance. Hospitals must give patients the chance to apply for discounted care when they have services at the hospital. Patients who are at or below 250% of the Federal Poverty Guidelines (FPG) are eligible for Hospital Discounted Care. It limits the amounts that low-income patients can be billed for health care services at hospitals and emergency rooms. It also limits amounts billed from physicians who provide services at hospitals and emergency rooms. If the patient qualifies, their billed amounts will be limited to the rates set by the Department of Health Care Policy and Financing (HCPF). See the Patient Rights document that was included within your hospital bill or the Patient Rights section below for more information.

Examples of Hospital Discounted Care Approximate Income Limits

Patient Rights

Beginning September 1, 2022, hospitals must inform all patients of their rights under Hospital Discounted Care. Information must be posted on the hospital’s website, available in waiting rooms, explained to patients while they are at the hospital in their preferred language, and included in bills from the hospital. If you did not get the Patients Rights information in any of these places, you can file a complaint with the Department of Health Care Policy and Financing (HCPF) at hcpf_HospDiscountCare@state.co.us 

Overview

• You may qualify if your income is low. Your gross household income must be 250% of the federal poverty guidelines or less. The hospital will help you see if you qualify.
• If you qualify:
  • Hospitals and providers must limit your bills.
  • You can get a payment plan. The plan is based on your income.
• You may qualify even if you:
  • Are not a citizen.
  • Are an immigrant.
  • Have health insurance.

Your Rights

• You have the right to ask the hospital to:
  • See if you can get Hospital Discounted Care or other help.
  • See if you can get Health First Colorado (Colorado Medicaid). 
  • See if you can get other programs.
  • Create a payment plan if you qualify.
• The hospital must give you information about your rights. The information must be in the language you prefer.

The Law about Bills from Hospitals and Providers

• You may get a bill from your hospital. You may also get bills from physicians who saw you in the hospital.
• If you qualify, any bill you get because of a hospital visit is limited. The bills cannot be more than Hospital Discounted Care allows.
  • You can look up the amounts for health care services at your hospital.
• Your bills must be split into monthly payments.
  • The amount you pay will depend on your income.
  • Monthly payments can’t be more than the amounts listed on your determination letter.
    • Monthly payments for hospital bills can’t be more than 4% of your monthly household income.
    • Monthly payments for physician bills can’t be more than 2% of your monthly household income.
  • If a bill has both hospital and physician charges, the monthly amount can’t be more than the monthly hospital and physician amounts added together.
  • If charges from a physician are billed on their own, each physician can set up a payment plan with you using the monthly physician amount.
• You do not owe any more money after:
  • You make 36 monthly payments, or
  • You pay the full discounted amount in your payment plan.

Public Health Coverage and Discounts

• If you do NOT have health insurance:
  • The hospital must see if you qualify for:
    • Public health coverage and discount programs, like Health First Colorado, Child Health Plan Plus (CHP+), Emergency Medicaid, and hospital discounts.
      • These can cover all or most of your health care bills.
  • The hospital must check to see if you qualify within 45 days of when you got care.
  • You can refuse to let the hospital see if you qualify. If you refuse:
    • You cannot sue the hospital for not giving you discounts.
    • You cannot sue the hospital for not checking for programs that can help you.
• If you have health insurance:
  • You must ask the hospital to see if you can get help with your bills.
  • The hospital has 45 days to see if you can get help after you ask them.

Determination and Appeals

• After you complete an application, the hospital must tell you if you qualify within 21 days.
• If you disagree with their decision, you can appeal.
  • You can disagree if the hospital determined you are not eligible and you think you are.
  • You can also disagree if the hospital determined you are eligible but the information used was wrong and your determination should have been lower.
• You must ask the hospital in writing for your case to be checked for mistakes.
  • You must file your appeal within 30 days of the date the hospital gave you their decision.
  • The hospital must give you the information on how to file an appeal.
  • The hospital must tell you they got your appeal within three business days of you sending it.
  • If you are having a hard time filing an appeal with the hospital, you can also file an appeal with the Department of Health Care Policy and Financing (HCPF) by emailing hcpf_HospDiscountCare@state.co.us 
• If the hospital does not change their decision after you appeal, you can file a second appeal to HCPF by emailing hcpf_HospDiscountCare@state.co.us 
  • You must send your appeal to HCPF within 15 calendar days of the hospital’s decision.
  • If HCPF determines that you should be eligible, the hospital must send you a new determination letter showing that you are eligible and discount your bills.
  • If HCPF determines that you are not eligible, the hospital is not required to discount your bill.
  • HCPF’s decision is the final decision.

Bill Collection with Hospital Discounted Care

• Before sending your bill to collections, the biller must:
  • Do what is listed above.
  • Explain all the services and fees on your bill. They must do this in the language you prefer.
  • Bill your insurance (if you have insurance) before making a payment plan.
  • Tell you in writing 30 days before they send you to collections.
• If your bill is sent to collections without doing all the steps listed above, you can file a complaint. You can also take legal action.

Hospital Discounted Care Complaints

• You can file a complaint if you feel any of your rights have not been met.
• Complaints may include:
  • Poor communication from the hospital financial assistance office.
  • Bills that are not properly discounted.
  • Missing or late paperwork or applications.
  • Not getting the Patient Rights document.
  • Anything else you want to tell us.
• If you have a billing complaint or issue, call the hospital billing department.
  • You will need to find the billing department phone number on the hospital or physician’s website or your bill.
  • The Department of Health Care Policy and Financing (HCPF) cannot change bills from the provider as we are not associated with them, only they can do that.
  • HCPF can help get your bill changed by the hospital or physician if you have qualified for Hospital Discounted Care and your bill has not been discounted.
• You can file a complaint with your hospital or physician. The hospital complaint information should be included with your patient rights statement in your bill.
• You can file a complaint with HCPF. Call 303-866-2580 or email hcpf_HospDiscountCare@state.co.us 

What Services are Covered?

Emergent and elective services received in a Health Care Facility at all Colorado general acute and critical access hospitals and their off-campus locations, all freestanding emergency departments may be covered. Services provided by Licensed Health Care Professionals in these settings are also covered. Hospital Discounted Care screens patients for eligibility for public health coverage, and discounted health care. Uninsured patients will automatically be screened and can choose not to be screened, but must opt out of the screening. Insured patients may ask to be screened to see if they qualify.

• Hospital Discounted Care Frequently Asked Questions

More Information about Hospital Discounted Care

If you would like to stay up to date with policy and rules, you can sign up to receive the Hospital Discounted Care newsletter. 

For additional information about Hospital Discounted Care, please visit the Hospital Discounted Care - Provider Information Page. 

Contact Information

Email:  HCPF_HospDiscountCare@state.co.us