When doctors aren’t part of the hospital’s financial assistance policy

Nonprofit hospitals have to provide financial assistance, which is free or discounted care for eligible patients. However, even if patients meet the income requirements for assistance, they may come up against another obstacle—clinicians who provide care at the hospital but are excluded from the policy.

In the hospital setting, a wide range of professionals work together to deliver healthcare services, each playing a crucial role in patient care. But not all of their services may be covered under a hospital’s financial assistance policy (FAP). For example, if doctors are not employed by the hospital, the hospital’s FAP may not apply to them.      

Hospitals are required to include in their FAPs a list that “specifies which providers are covered by the FAP and which are not.” However the way in which hospitals share this information can be very different, often making it hard for patients to find out whether their provider is covered or not.  

Variation in FAP provider coverage information

Hospitals vary in which providers are covered under the FAP, and how they share this information. For example, here are three hospitals on the US News 2023-24 “Best Hospitals” list. These are similar hospitals in size and quality, but they differ in how providers are covered under the FAP and how they make this information available.

HospitalDo they list included/ excluded providers in the FAP?What information is included?
Mount Sinai Hospital, New York City
Yes (link)
Mount Sinai Hospital has a list of about 1,750 providers, including their name, department, NPI number, employment status, and whether they are covered under the FAP.
Houston Methodist HospitalSomewhat (link)Within the FAP for the hospital system, there is an appendix that is a “List of Providers that are/are not covered by this Policy,” listed by organization or practice, but individual clinicians are not named.
Hospital of the University of Pennsylvania, PhiladelphiaNoThe FAP provides a link to all UPHS providers and states that providers “who are identified as NOT employed by Penn Medicine are not subject to this policy.” The FAP does not include a list of excluded or covered providers.

The fact that not all healthcare providers at a hospital are subject to the hospital’s financial assistance policy shows just how opaque and complex the process of receiving assistance can be. Even if a patient is eligible for assistance based on their income, assets, and any other criteria the hospital has, they may not be able to access assistance because of who is providing it. 

Ultimately, this ambiguity creates a significant challenge for patients, particularly those facing financial difficulties. As patients attempt to navigate the financing of healthcare services, this lack of clarity and consistency in hospital FAPs not only complicates their ability to make informed financial decisions.