Health You can ask a hospital for an itemized bill and apply for charity care — many patients qualify and never ask By Tyler Foster, Tens of thousands of patients have been sent to collections for hospital bills they may never have owed. A case brought by the Washington State Attorney General against Providence’s collection agencies found that collectors pursued hundreds of millions of dollars in medical debt while failing to inform patients of their right to request an itemized statement or apply for charity care. Federal law already requires nonprofit hospitals to screen patients for financial assistance before aggressive collection, yet the gap between what patients are entitled to and what they actually receive remains wide. Federal rules hospitals must follow before sending bills to collections Every nonprofit hospital in the United States must maintain a written Financial Assistance Policy under IRC Section 501(r). That policy must be summarized in plain language and handed to patients at intake and discharge. Billing statements must include a conspicuous notice of the policy along with a URL or phone number where patients can learn more. These are not suggestions. They are conditions of the hospital’s tax-exempt status. Before a nonprofit hospital can take what the IRS calls “extraordinary collection actions,” such as selling debt to a collector, reporting to credit bureaus, or filing a lawsuit, it must make reasonable efforts to determine whether the patient qualifies for financial assistance. That means the hospital cannot simply hand off a bill and walk away. If it skips this step, it risks its 501(r) compliance and, by extension, its nonprofit standing. The problem is enforcement. No publicly available federal dataset tracks how many hospitals post their Financial Assistance Policy notices at rates above the IRS minimum