1. Itemize before you pay.
A “balance due” is a summary. Duplicate labs, canceled imaging, canceled OR time, and leftover supplies live in the line items. Ask for the UB-04 or a CPT/HCPCS ledger and a 30-day hold. That letter is free in UNDUE because it should always go first.
2. Ask for the FAP, not a manager.
If the hospital is a 501(c)(3), Internal Revenue Code 501(r) requires a written Financial Assistance Policy, a plain-language summary, and limits on extraordinary collection actions while an application is pending. You are not asking for a favor. You are asking them to run their own policy.
Typical nonprofit FAPs: 100% write-off at or under 200% of FPL, sliding scale to 300–400%. 14 states go further and set a legal floor. Open the 50-state desk before you assume 200% is the line.
3. 2026 poverty guidelines.
UNDUE scores income against HHS figures effective January 2026 for the 48 contiguous states and D.C. Alaska and Hawaii use their own tables. Then it overlays that state’s statute — California eligibility at 400% FPL is not the same machine as Florida, which has no floor at all.
| Household | 100% FPL | 200% FPL |
|---|---|---|
| 1 | $15,960 | $31,920 |
| 2 | $21,640 | $43,280 |
| 3 | $27,320 | $54,640 |
| 4 | $33,000 | $66,000 |
| 5 | $38,680 | $77,360 |
| 6 | $44,360 | $88,720 |
4. Chargemaster is not a cash price.
Uninsured and high-deductible patients are often billed sticker rates several times Medicare. Ask for the self-pay or prompt-pay schedule, or the rate the hospital takes from Medicare or its largest commercial payer. Colorado, Connecticut, Illinois, and Nevada have additional uninsured-rate statutes. Then, if needed, offer a lump sum for a paid-in-full letter.
5. If it’s in collections, validate.
The Fair Debt Collection Practices Act (15 U.S.C. § 1692g) lets you demand proof of the debt. Do not pay, payment-plan, or “just get them off the phone” until the original creditor, the amount, and the date of service are in writing. Charity care can still apply to hospital-origin debt. New Mexico can halt collection for indigent patients on a signed attestation. A partial payment can restart the lawsuit clock in most states.
6. Keep a paper trail.
Send certified mail or the hospital’s posted billing email. Note the date, the person, and the reference number on every call. Calendar a follow-up at 14 days. If they ignore a pending FAP application and send you to collections, that is the record.
7. File the forms yourself.
After the letters, UNDUE builds a filing packet from the same case: the hospital’s posted financial-assistance application if that system is on file, a worksheet filled from your name, account, income, and FPL math, and paste-ready complaints for the attorney general, the CFPB, CMS (No Surprises), and the IRS (501(r)). Copy the worksheet onto the hospital’s official form. Put Social Security numbers only on their form. Mail theirs. UNDUE does not submit, store medical files, or invent a hospital URL when the provider is not on the match list — call billing and ask for the application.