If you were billed by Providence for hospital care when you may have qualified for free or discounted treatment, you are not alone, and you may be owed money. Providence Health & Services agreed in February 2024 to provide $157.8 million in refunds and debt relief to Washington patients after the state Attorney General found the system had pursued payment from tens of thousands of low-income patients who should have received charity care. The Providence charity care billing resolution covers care received between 2018 and October 2023, and separate rules let you apply for financial assistance or dispute a bill at any time, including after your account has gone to collections.
Why Patients Were Wrongly Billed
Starting in 2018, Providence rolled out an internal revenue program called “Rev-Up,” designed with McKinsey & Company, that trained staff to ask every patient for payment at every encounter. Workers were coached not to accept a first “no” and were told that asking for money was “part of your role” and “not an option.” The program operated without first screening patients for financial assistance eligibility, and patients who did not pay were turned over to outside debt collectors.
The result, according to the Washington Attorney General’s office, was that more than 54,000 low-income patients eligible for free or discounted care were sent to collections. Providence’s charity care spending fell from 1.8 percent of expenses in 2018 to below 1 percent after Rev-Up launched. Providence later said the training materials “were not consistent with our values” and told Senator Patty Murray that Rev-Up was “short-lived” and “no longer exists.”
Are You Covered by the Washington Settlement?
You may be covered if you received care at a Providence-affiliated hospital in Washington between 2018 and October 2023. The agreement, filed in King County Superior Court, applies to 14 Providence hospitals in the state along with Swedish Medical Center and Kadlec Regional Medical Center.
The $157.8 million resolution breaks down into:
- $137.2 million in medical debt erased for 65,217 patients, with the average write-off above $900.
- $20.6 million in direct refunds, plus 12 percent interest, to 34,229 patients who had already paid bills despite likely being eligible for free or discounted care. The average refund is roughly $478.
- $4.5 million to cover the Attorney General’s investigative costs.
Providence began issuing refunds and said it was continuing to review patient files to identify everyone eligible. Patients who qualify were to receive letters informing them of the resolution. If you believe you qualify and have not heard from Providence, call the patient billing office at 800-378-4189 and ask for a review under the Attorney General resolution.
If you received care in Oregon, the state Department of Justice opened its own civil investigation in October 2022 into similar allegations, and that case is ongoing. No patient resolution has been announced there.
How to Apply for Providence Financial Assistance Now
Providence’s current financial assistance policies vary by state but generally follow the same tiers:
- Patients with family income at or below 300 percent of the federal poverty level qualify for a 100 percent write-off of eligible charges.
- Patients between 301 and 400 percent of the federal poverty level receive discounts ranging from 70 to 87 percent, depending on the state.
- Patients at or below 400 percent of the federal poverty level whose Providence medical costs exceeded 20 percent of their annual income over the prior 12 months may qualify for a complete write-off under the catastrophic medical expense provision.
- Providence may also grant presumptive eligibility without a full application if a financial assessment or participation in programs like Medicaid, CalFresh, or WIC indicates you qualify.
You can submit an application by mail, online at providence.org/financialhelp, or in person at any Providence facility. Processing generally takes 30 days, or 14 days in Washington. Financial counselors can be reached at 855-229-6466.
You can apply at any point, including after a bill has gone to collections. Once you apply, your account is placed on hold and removed from collections while Providence reviews it.
How to Dispute a Providence Bill
If you believe a charge is incorrect, call the Providence patient billing office at 800-378-4189 or the number printed on your bill. You can also dispute in writing by sending a letter to the hospital address on your statement. Include your name, the account number, the specific charge you are disputing, and an explanation of why you believe it is wrong.
Providence must acknowledge receipt of a written dispute within 30 days and provide a substantive response within 60 days. Collection activity pauses while the dispute is under review.
If you cannot pay in full and do not qualify for charity care, Providence offers interest-free payment plans starting at $25 per month.
Extra Protections if You Live in Washington
Washington state law requires hospitals to notify patients about charity care programs upon admission, and you can apply for charity care at any time, even after a debt has been sent to a collection agency or a lawsuit has been filed. That right survives collection activity, so a collector contacting you is not the end of your options.
When a collection agency contacts you about medical debt in Washington, it must disclose your right to request an itemized statement showing the services, dates, amounts, and whether charity care was applied. Ask for it in writing and keep a copy.
If you believe your rights have been violated, the Washington State Office of the Insurance Commissioner’s consumer hotline is 1-800-562-6900. In Oregon, the Division of Financial Regulation can be reached at 503-947-7984.
Surprise Billing Is a Separate Issue
Charity care and surprise billing are different problems with different remedies. Under the federal No Surprises Act, Providence Health Plan members are protected from balance billing for emergency services and for certain out-of-network services received at in-network facilities. If you think you were improperly balance-billed, contact Providence Health Plan at 503-574-7500 or the federal No Surprises Help Desk at 1-800-985-3059. A balance-billing complaint is not the same as a charity care application, and if you qualify for financial assistance you should file that application separately.
What to Do Next
Pull out any Providence bill from 2018 forward, including bills you already paid. If your household income was at or below 400 percent of the federal poverty level at the time of care, submit a financial assistance application and ask Providence to review the account under the Washington Attorney General resolution. If a collector is contacting you, request the itemized statement in writing and tell the collector you are applying for charity care so the account goes on hold. If Providence does not respond within the required timelines, contact the Washington Attorney General’s office or your state insurance regulator.