# Hospital and medical bills you cannot pay: research log

Research by Known Quantity LLC for /for-good/hospital-bill/. Read and checked 2026-11-13.
Rule: every deadline, dollar amount, percentage, phone number and legal statement on the page traces to a row here (row ids H1, H2, ...). Quotes are kept short and exact.

How sources were read: WebFetch (page text extracted by a reader model) and WebSearch, on 2026-11-13. The shell could not reach these sites directly. Where two sources exist for a figure, both are listed. Where they differ, the row says so.

This log is general information, not legal advice. Rules differ by state, by hospital and by plan. The person's own bill, notice or court papers come first.

## Sources

| id | Title | Date | Publisher | URL | Kind |
|---|---|---|---|---|---|
| I1 | 26 CFR 1.501(r)-1, Definitions | current text, read 2026-11-13 | Code of Federal Regulations, via Cornell LII | https://www.law.cornell.edu/cfr/text/26/1.501(r)-1 | Primary (regulation) |
| I2 | 26 CFR 1.501(r)-4, Financial assistance policy and emergency medical care policy | current text, read 2026-11-13 | Code of Federal Regulations, via Cornell LII | https://www.law.cornell.edu/cfr/text/26/1.501(r)-4 | Primary (regulation) |
| I3 | 26 CFR 1.501(r)-5, Limitation on charges | current text, read 2026-11-13 | Code of Federal Regulations, via Cornell LII | https://www.law.cornell.edu/cfr/text/26/1.501(r)-5 | Primary (regulation) |
| I4 | 26 CFR 1.501(r)-6, Billing and collection | current text, read 2026-11-13 | Code of Federal Regulations, via Cornell LII | https://www.law.cornell.edu/cfr/text/26/1.501(r)-6 | Primary (regulation) |
| I5 | Billing and Collections, Section 501(r)(6) | read 2026-11-13 | IRS | https://www.irs.gov/charities-non-profits/billing-and-collections-section-501r6 | Primary (government guidance) |
| I6 | Financial Assistance Policies (FAPs) | read 2026-11-13 (IRS marks the page historical) | IRS | https://www.irs.gov/charities-non-profits/financial-assistance-policies-faps | Primary (government guidance) |
| N1 | Medical bill rights | read 2026-11-13 | CMS | https://www.cms.gov/medical-bill-rights | Primary (government guidance) |
| N2 | Know your rights when using insurance | read 2026-11-13 | CMS | https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/know-your-rights/insurance | Primary (government guidance) |
| N3 | Know your rights when not using insurance | read 2026-11-13 | CMS | https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/know-your-rights/without-insurance | Primary (government guidance) |
| N4 | Dispute a bill | read 2026-11-13 | CMS | https://www.cms.gov/initiatives/your-patient-rights/medical-bill-rights/get-help/dispute-bill | Primary (government guidance) |
| N5 | Help resources (No Surprises Help Desk) | read 2026-11-13 | CMS | https://www.cms.gov/medical-bill-rights/help | Primary (government) |
| N6 | 45 CFR 149.620, Requirements for the patient-provider dispute resolution process | current text, read 2026-11-13 | Code of Federal Regulations, via Cornell LII | https://www.law.cornell.edu/cfr/text/45/149.620 | Primary (regulation) |
| P1 | Poverty guidelines | read 2026-11-13 | HHS, ASPE | https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines | Primary (government) |
| P2 | Annual Update of the HHS Poverty Guidelines, 91 FR (Jan 15, 2026), doc 2026-00755 | 2026-01-15 | Federal Register (GovInfo) | https://www.govinfo.gov/content/pkg/FR-2026-01-15/html/2026-00755.htm | Primary (government) |
| K1 | Hospital Charity Care: How It Works and Why It Matters | 2022-11-03 (modified 2025-08-09) | KFF | https://www.kff.org/health-costs/issue-brief/hospital-charity-care-how-it-works-and-why-it-matters/ | Research |
| C1 | 15 U.S.C. 1692g, Validation of debts (Fair Debt Collection Practices Act) | current text, read 2026-11-13 | U.S. Code, via Cornell LII | https://www.law.cornell.edu/uscode/text/15/1692g | Primary (statute) |
| C2 | 12 CFR 1006.34, Notice for validation of debts (Regulation F) | current text, read 2026-11-13 | Code of Federal Regulations, via Cornell LII | https://www.law.cornell.edu/cfr/text/12/1006.34 | Primary (regulation) |
| C3 | What information does a debt collector have to give me about a debt? | read 2026-11-13 | CFPB | https://www.consumerfinance.gov/ask-cfpb/what-information-does-a-debt-collector-have-to-give-me-about-a-debt-they-are-trying-to-collect-from-me-en-331/ | Primary (government guidance) |
| C4 | What should I do if I can't pay a medical bill? | last reviewed 2026-10-28 | CFPB | https://www.consumerfinance.gov/ask-cfpb/what-should-i-do-if-i-cant-pay-a-medical-bill-en-2125/ | Primary (government guidance) |
| C5 | Consumer advisory: pause and review your rights when you hear from a medical debt collector | read 2026-11-13 | CFPB | https://www.consumerfinance.gov/about-us/newsroom/consumer-advisory-pause-and-review-your-rights-when-you-hear-from-a-medical-debt-collector | Primary (government guidance) |
| C6 | What should I do if I'm sued by a debt collector or creditor? | last reviewed 2026-10-28 | CFPB | https://www.consumerfinance.gov/ask-cfpb/what-should-i-do-if-im-sued-by-a-debt-collector-or-creditor-en-334/ | Primary (government guidance) |
| C7 | Medical debt: anything already paid or under $500 should no longer be on your credit report | 2023-05-08 (archived) | CFPB | https://www.consumerfinance.gov/about-us/blog/medical-debt-anything-already-paid-or-under-500-should-no-longer-be-on-your-credit-report/ | Primary (government) |
| C8 | Equifax, Experian and TransUnion Remove Medical Collections Debt Under $500 From U.S. Credit Reports | 2023-04-11 | TransUnion newsroom (joint announcement of the three bureaus) | https://newsroom.transunion.com/equifax-experian-and-transunion-remove-medical-collections-debt-under-500-from-us-credit-reports/ | Company announcement |
| C9 | Prohibition on Creditors and Consumer Reporting Agencies Concerning Medical Information (Regulation V) | rule issued 2025-01-07; read 2026-11-13 | CFPB | https://www.consumerfinance.gov/rules-policy/final-rules/prohibition-on-creditors-and-consumer-reporting-agencies-concerning-medical-information-regulation-v/ | Primary (government) |
| C10 | The Latest on Keeping Medical Debt Out of Credit Reports | 2025-07-30, updated 2026-09-21 | National Consumer Law Center | https://library.nclc.org/article/latest-keeping-medical-debt-out-credit-reports | Legal nonprofit analysis |
| M1 | 42 CFR 435.915, Effective date (Medicaid retroactive eligibility) | current text, read 2026-11-13 | Code of Federal Regulations, via Cornell LII | https://www.law.cornell.edu/cfr/text/42/435.915 | Primary (regulation) |
| M2 | CMCS Informational Bulletin: Medicaid eligibility provisions of the Working Families Tax Cut legislation | 2025-11-18 | CMS (Medicaid.gov) | https://www.medicaid.gov/federal-policy-guidance/downloads/cib11182025.pdf | Primary (government guidance) |
| M3 | Getting Medicaid and CHIP | read 2026-11-13 | HealthCare.gov (CMS) | https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/ | Primary (government guidance) |
| M4 | Where can people get help with Medicaid and CHIP? (state contacts) | read 2026-11-13 for the denial page | Medicaid.gov | https://www.medicaid.gov/about-us/where-can-people-get-help-medicaid-chip | Primary (government) |
| L1 | LawHelp.org | read 2026-11-13 | Pro Bono Net (nonprofit) | https://www.lawhelp.org/ | Nonprofit directory |
| L2 | Dollar For | read 2026-11-13 | Dollar For | https://dollarfor.org/ | Nonprofit service |

## A. Nonprofit hospitals: financial assistance (section 501(r))

Who: hospital organizations recognized (or seeking recognition) as tax-exempt under section 501(c)(3) (I1 (b)(18)). For-profit hospitals are not covered by these rules. Government hospitals are covered only if they also hold 501(c)(3) status; the page does not try to sort that out and says "ask".

| id | Claim | Figure | Applies to | Source | Quote / note |
|---|---|---|---|---|---|
| H1 | Who the rules cover | 501(c)(3) organizations that operate hospital facilities | Nonprofit hospitals | I1 (b)(18) | "an organization recognized (or seeking to be recognized) as described in section 501(c)(3)" |
| H2 | A written financial assistance policy (FAP) is required, covering emergency and other medically necessary care | yes | Nonprofit hospitals | I6; I2 (b)(1)(i) | I6: "requires a tax-exempt hospital organization to establish a written financial assistance policy (FAP)" |
| H3 | What the FAP must say | eligibility criteria and whether free or discounted care; basis for amounts charged; how to apply; which outside providers in the hospital are covered | Nonprofit hospitals | I2 (b)(1)(iii)(A)-(C), (F) | "The eligibility criteria for financial assistance and whether such assistance includes free or discounted care"; "The method for applying for financial assistance" |
| H4 | The hospital may not deny help because of missing information the policy or form did not ask for | yes | Nonprofit hospitals | I2 (b)(3) | "may not deny financial assistance under its FAP based on an applicant's failure to provide information" |
| H5 | The FAP, application and plain language summary must be on a website, and paper copies free on request | yes | Nonprofit hospitals | I2 (b)(5)(i)(A)-(B); I6 | I2: "available upon request and without charge, both by mail and in public locations" |
| H6 | Bills must carry a notice about financial assistance with a phone number | yes | Nonprofit hospitals | I2 (b)(5)(i)(D); I6 | I6: "a conspicuous written notice on billing statements" |
| H7 | Charge limit for people who qualify | not more than amounts generally billed (AGB) to people with insurance, for emergency or medically necessary care | Nonprofit hospitals | I3 (a)(1); I2 (b)(2) | I3: "not more than the amounts generally billed to individuals who have insurance covering such care (AGB)" |
| H8 | Notification period | 120 days from the first post-discharge bill, before extraordinary collection actions (ECAs) may start | Nonprofit hospitals | I4 (c)(3)(i); I5 | I4: "for at least 120 days from the date the hospital facility provides the first post-discharge billing statement" |
| H9 | Application period | ends no earlier than the 240th day after the first post-discharge bill | Nonprofit hospitals | I1 (b)(3); I5 | I5: "120-day 'notification period' and a 240-day 'application period'" |
| H10 | What counts as an extraordinary collection action | selling the debt; reporting to credit bureaus; delaying or denying needed care over old bills; liens, foreclosure, seizing bank accounts, lawsuits, arrest, wage garnishment | Nonprofit hospitals | I4 (b)(1) | "Reporting adverse information about the individual to consumer credit reporting agencies or credit bureaus." "Garnishing an individual's wages." |
| H11 | Written notice before ECAs | at least 30 days before the first ECA | Nonprofit hospitals | I4 (c)(4)(i)(A) | "at least 30 days before first initiating one or more ECA(s)" |
| H12 | If you apply during the application period, ECAs stop until the hospital decides | yes | Nonprofit hospitals | I4 (c)(8); I5 | I4: "does not initiate, or take further action on any previously-initiated, ECAs". I5: "Suspend any ECAs taken against the individual" |
| H13 | If you qualify: refund of amounts paid above what you owe (unless under $5), and the hospital must try to reverse ECAs | yes | Nonprofit hospitals | I4 (c)(6)(i)(C)(2)-(3) | "unless such excess amount is less than $5"; "Takes all reasonably available measures to reverse any ECA" |
| H14 | Federal rules do not set who qualifies; each hospital sets its own criteria | yes | Nonprofit hospitals | K1 | "Federal regulations do not currently define or set minimum standards"; "eligibility criteria vary across hospitals" |
| H15 | KFF study of nonprofit hospital policies (2018 data): about one in three limited free care to incomes at or below 200% of the poverty guideline; about 62% limited discounts to incomes at or below 400% | 32% at 200%; 62% at 400% | Nonprofit hospitals, 2018 | K1 | "about one in three (32%) of the hospitals required patients to have incomes at or below 200 percent of the FPL". The page reports these as one study's findings, not as a rule. |
| H16 | Some states require charity care from all or some hospitals, including some for-profit and public hospitals | 26 states and DC (2021, NCLC, via KFF) | State law | K1 | "Slightly over half of all states (26 states and DC) require all or a subset of hospitals". The page says "some states", not a count, because the count is from 2021. |

Not used: the claim that "many hospital policies give free or discounted care between 200% and 400%" as a general rule. KFF's one study (H15) is shown instead, with its year.

## B. Federal poverty guidelines, 2026

Published in the Federal Register on 2026-01-15 (P2), effective 2026-01-13 unless a program sets another date. Both P1 and P2 show the same figures. Figures are yearly household income in dollars, for household sizes 1 to 8, then the amount added for each person over 8.

| id | Area | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | each extra |
|---|---|---|---|---|---|---|---|---|---|---|
| PG48 | 48 contiguous states and DC | 15960 | 21640 | 27320 | 33000 | 38680 | 44360 | 50040 | 55720 | 5680 |
| PGAK | Alaska | 19950 | 27050 | 34150 | 41250 | 48350 | 55450 | 62550 | 69650 | 7100 |
| PGHI | Hawaii | 18360 | 24890 | 31420 | 37950 | 44480 | 51010 | 57540 | 64070 | 6530 |

| id | Claim | Source | Note |
|---|---|---|---|
| H20 | The 2026 guidelines are the latest published | P1; P2 | P2: "Effective Date: January 13, 2026." Percentage shown on the page = income / guideline for the household size x 100, rounded to a whole number, computed on the device. |

## C. Surprise bills (No Surprises Act)

| id | Claim | Figure | Applies to | Source | Quote / note |
|---|---|---|---|---|---|
| H30 | Who the protections cover | job-based plans (including FEHB), Marketplace and other individual plans | Private health coverage | N2 | Not generally: vision-only or dental-only, short-term, health care sharing ministry or fixed indemnity plans |
| H31 | Emergency care: no more than in-network cost-sharing, from the hospital, its doctors or an air ambulance | yes | Private coverage | N2; N1 | N2: "you can't be charged any more for emergency medical services than the in-network "cost-sharing" rate" |
| H32 | Out-of-network providers at an in-network hospital, outpatient department or surgery center | protected, unless you signed a notice and consent form; not allowed for emergency care | Private coverage | N2 | "You may lose these billing protections if you sign a notice and consent form." |
| H33 | Air ambulance covered; ground ambulance not covered | | Private coverage | N2; N1 | N2: "ground ambulance services aren't covered by billing protections in the No Surprises Act." State law may help; the page says "ask". |
| H34 | Medicare, Medicaid, IHS, VA and TRICARE already protect from some out-of-network bills | | Government coverage | N2 | "already protect you from some unexpected out-of-network bills" |
| H35 | Good faith estimate for people without insurance or not using it | when you schedule at least 3 business days ahead, or when you ask; not during emergency care | Uninsured or self-pay | N3; N1 | N3: "when you schedule care at least 3 business days in advance or if you ask for one"; "You won't get an estimate during emergency care." |
| H36 | Patient-provider dispute: bill at least $400 more than the estimate | $400 | Uninsured or self-pay, care on or after 2022-01-01 | N4; N6 (a)(2)(ii); N3 | N4: "charged at least $400 more than their good faith estimate" |
| H37 | Time to start the dispute | 120 calendar days | Uninsured or self-pay | N4; N6 (c)(1) | N4: "an initial bill dated within the last 120 calendar days". N6: within 120 calendar days of "receiving the initial bill". Sources differ on the start (bill date vs receipt); the page counts from the date on the bill, the earlier and safer date. |
| H38 | Dispute fee | $25, not refundable | Uninsured or self-pay | N4 | "$25 non-refundable administrative fee". N6 says the amount is set by guidance. |
| H39 | No collections on the disputed bill during the dispute | yes; if already in collections, collection must stop | Uninsured or self-pay | N4; N6 (c)(5) | N4: "must stop pursuing payment until the dispute process is resolved" |
| H40 | No Surprises Help Desk | 1-800-985-3059; weekdays 8 am to 8 pm ET, weekends 10 am to 6 pm ET | Everyone | N5; N1 | N5: "1-800-985-3059"; "7 days a week" |

## D. Debt collectors

| id | Claim | Figure | Applies to | Source | Quote / note |
|---|---|---|---|---|---|
| H50 | Time to dispute a debt in writing | 30 days after receiving the validation notice | Third-party debt collectors | C1 (a)(3)-(4); C3 | C3: "you have 30 days to dispute the debt in writing" |
| H51 | The notice must give the end date of the 30-day period | yes | Debt collectors | C2 (c)(3)(i); C2 (b)(5); C3 | C2: the period ends "30 days after the consumer receives or is assumed to receive the validation information". The page counts from the date on the notice (earlier, safer) and says the date on the notice comes first. |
| H52 | After a written dispute in time, collection stops until verification is mailed | yes | Debt collectors | C1 (b) | "the debt collector shall cease collection of the debt, or any disputed portion thereof," |
| H53 | Name and address of the original creditor on written request within the 30 days | yes | Debt collectors | C1 (a)(5) | "the name and address of the original creditor, if different from the current creditor" |
| H54 | If sued: respond by the date in the court papers; otherwise a default judgment can follow (wage garnishment, liens, frozen bank funds) | | Everyone | C6 | "you should respond to the lawsuit, either personally or through a lawyer by the date specified in the court papers" |

## E. Medical debt and credit reports (status on 2026-11-13)

| id | Claim | Figure | Source | Quote / note |
|---|---|---|---|---|
| H60 | Paid medical collections no longer on reports from the three national bureaus | since July 1, 2022 | C8; C7 | C8: "as of July 1, 2022, all medical collection debt that has been paid by the consumer in full is no longer included" |
| H61 | Unpaid medical collections wait one year before they can appear | one year (was six months) | C8; C7 | C8: "increased from six months to one year". C7 words it as one year "from the time you saw a doctor"; the page says "at least a year". |
| H62 | Medical collections under $500 removed | under $500, from April 11, 2023 | C7; C8 | C7: "This last step went into effect on April 11, 2023." |
| H63 | These three changes are voluntary bureau policies, not a law | | C10; C7 | C10 (updated 2026-09-21) describes them as the bureaus' voluntary commitments and reports no change to them. We did not find a 2026 statement from the bureaus themselves; the page says "As of our last check". |
| H64 | CFPB rule to remove medical debt from credit reports | issued January 7, 2025; vacated by a federal court in Texas on July 11, 2025 | C9; C10 | C9: the court "vacated the Consumer Financial Protection Bureau's rule". C10: Cornerstone Credit Union League v. CFPB (E.D. Tex. July 11, 2025). The rule never took effect. |
| H65 | Some states have their own laws limiting medical debt on credit reports; courts disagree on whether federal law overrides them | 15 states and DC listed by NCLC (2026-09-21) | C10 | The page says "some states" and "ask legal aid", without a list, because these laws are being challenged in court. |

## F. Paying, checking and negotiating

| id | Claim | Source | Quote / note |
|---|---|---|---|
| H70 | Ask for an itemized list of charges | C4; C5 | C4: "If something doesn't look right, ask for an itemized list of charges." No general federal right to an itemized bill was found; the page says "ask". |
| H71 | What to look for: the same charge twice; wrong dates, medicines or procedures; charges already paid by you or your insurance | C4; C5 | C5: "wrong dates, medications, or procedures"; "already paid by you or by your insurance" |
| H72 | Be careful paying a medical bill with a credit card or medical credit card | C4; C5 | C4: "There may be high interest and you may lose the ability to negotiate the debt." C5: "Try to avoid paying off medical charges using a credit card or other loan" |
| H73 | Ask for an interest-free payment plan; negotiate the bill | C4 | C4: "Ask if the provider will accept an interest-free repayment plan" |

## G. Medicaid

| id | Claim | Figure | Source | Quote / note |
|---|---|---|---|---|
| H80 | Apply any time of year, through the state agency or the Marketplace | | M3 | "You can apply for Medicaid and CHIP any time of year." |
| H81 | Retroactive coverage today | up to the third month before the month of application, if eligible then | M1 (a) | "no later than the third month before the month of application". Some states have federal waivers that change this; not verified state by state, so the page says "ask your state". |
| H82 | Change for applications on or after January 1, 2027 | one month before for expansion adults; two months for others | M2 | "Effective for applications made on or after January 1, 2027." |
| H83 | State Medicaid agency contacts | | M4 | Linked, not listed |

## H. Free help

| id | Claim | Source | Quote / note |
|---|---|---|---|
| H90 | LawHelp.org finds nonprofit legal aid in every state and territory | L1 | "LawHelp.org and state LawHelp sites are maintained by Pro Bono Net" |
| H91 | Dollar For says it helps people apply for hospital financial assistance for free | L2 | "We can help you apply" ... "for free." (dollarfor.org home page, read 2026-11-13; a dash between the two parts is left out here). We have no tie to Dollar For. |
| H92 | No Surprises Help Desk | N5 | See H40 |

## Could not verify today (left off the page)

- A general federal right to an itemized hospital bill: not found. The page says "ask". Some states have such rights; not checked state by state.
- "Many hospital policies give free or discounted care between 200% and 400% of the guideline" as a general statement: only one study (KFF, 2018 data) found; shown with its year instead.
- A 2026 statement from Equifax, Experian or TransUnion themselves confirming the voluntary medical debt policies: Equifax's page body could not be read; Experian's page did not cover it. The page relies on NCLC's September 21, 2026 update (no change reported) and says "as of our last check".
- Whether anyone appealed the July 11, 2025 decision vacating the CFPB rule: not found. CFPB itself asked for the rule to be vacated.
- Which states have Medicaid waivers that limit or remove retroactive coverage: not checked; the page says "ask your state".
- A current list of state consumer assistance programs: not used (same gap as the denial page).
- Self-pay or prompt-pay discounts: no source says they must exist. The page says "ask".
- State surprise-billing laws for ground ambulances: not checked; the page says "ask".