A $5,700 hernia bill fell to $0 after a charity-care appeal
Jose Saldana's documented Loyola University Medical Center case shows how a $5,700 additional hernia bill reached $0 after a charity-care denial, appeal, and refund verification, with adapted scripts and a 72-hour checklist.
The short version
The balance under review was an additional $5,700 hernia-surgery bill from Loyola University Medical Center in Chicago. Jose Saldana had already paid $1,000 upfront for the surgery, then called the hospital and entered an $80-a-month payment plan. The hospital did not tell him about financial assistance. After his wife found Dollar For, Jose completed a charity-care application, appealed after the first denial, and eventually received a refund for the $80 payments he had already made. The $5,700 balance fell to $0: a $5,700 reduction, or 100%. 1
| What changed | Amount |
|---|---|
| Additional hernia bill under review | $5,700 |
| Final balance reported by the source | $0 |
| Dollar reduction | $5,700 |
| Percentage reduction | 100% |
The source does not disclose Jose's insurance status. It does document a layoff after 25 years in one job, a six-person household, and a payment burden that competed with food and other household needs. The $1,000 upfront surgery payment is a separate amount already paid; this article measures the reduction on the additional $5,700 bill.
The repeatable part of the case is the route: call billing, ask about assistance, gather the documents, appeal a denial, and verify the written result. Dollar For's page does not publish a verbatim billing transcript or the text of Jose's application. The scripts below are therefore adapted scripts, not quotations from Jose.
Case: the payment plan that was not the final answer
Jose was laid off at the start of the pandemic after working for the same employer for 25 years. He is a father of six. After a second medical opinion, a doctor diagnosed a hernia and told him to seek treatment quickly. Jose went to Loyola University Medical Center in Chicago and was treated successfully. 1
The billing problem came after the surgery. Jose had paid $1,000 upfront, then received an additional $5,700 bill. He called the hospital and was placed on a payment plan of $80 per month for five years. The account representative did not mention financial assistance, according to Dollar For's account. 1
Jose described the monthly amount in plain terms: "When you're living check by check, $80 is a lot." He said the family had to choose between food and the medical bill and "cut a lot of corners." Those are source-reported words, not a general claim about every payment plan. 1
The first useful distinction is between making an account payable and making an account affordable. A payment plan changes the timing of payments. Financial assistance can change the balance itself. A plan can be worth requesting while a charity-care review is pending, because an account still needs a safe status while the patient looks for relief. The plan should not end the search for the hospital's written assistance policy.
The sequence that produced the result
Dollar For's account gives enough detail to reconstruct the path without inventing a magic sentence:
- Jose called the hospital's finance side. The call produced an $80-a-month payment plan for the $5,700 balance.
- His wife found another route. She heard about Dollar For through a TikTok "hack" and encouraged Jose to apply for help with the hospital bill.
- The patient advocacy team collected paperwork. Dollar For worked with Jose to gather the documents needed for a charity-care application.
- The first application was denied. Jose said he was ready to give up and did not think an appeal would make sense.
- The appeal went forward anyway. Dollar For and Jose's wife urged him to appeal again.
- The debt was forgiven. Dollar For reports that the $5,700 debt was 100% forgiven and that Jose received a refund check for the $80 payments he had already made.
- Jose verified the refund. He called the finance company to confirm that the money was legitimate before using it for household bills. 1
The denial is the part most patients need to plan for. An application can fail because a document is missing, an income figure is misunderstood, a deadline was missed, or the hospital needs a different form. Jose's source does not say why the first application was denied. That reason belongs on your next call or letter; it should not be guessed.
What to collect before you apply or appeal
Ask the hospital's billing or financial-assistance department for its written policy and application. CMS says the policy should explain the eligibility rules, the application process, the deadline, the contact person, and what happens to the account while the application is pending. 2
Prepare a folder with:
- the bill, account number, and every service date;
- the complete itemized bill, including charges, adjustments, payments, and current balance;
- the hospital's financial-assistance policy and application;
- recent pay stubs or other proof of current income;
- tax returns or the hospital's substitute form if you did not file;
- bank statements or other documents the application specifically requests;
- layoff, unemployment, or hardship records when they explain a change in the household's ability to pay;
- copies of every submission, delivery confirmation, appeal, and written response.
Dollar For's charity-care handbook describes a do-it-yourself route: find the hospital policy, compare its eligibility rules with your situation, complete the hospital's application, submit it through the accepted channel, follow up to confirm receipt, and appeal or reapply after a denial. The handbook also directs patients to keep working on other reduction routes if charity care does not resolve the balance. 3
A practical follow-up rhythm is simple: confirm that the hospital received the application, ask what is missing, and write down the next date. Dollar For's page gives a successful appeal as the reason to keep the file active. It does not tell us which document changed Jose's outcome, so your record should preserve the hospital's explanation rather than assume that a second submission alone guarantees approval.
Adapted scripts for the same path
Jose did not publish the exact words he used with Loyola, Dollar For, or the finance company. The following language is adapted from the documented sequence. Replace the brackets with your own information and ask the hospital to confirm every answer in writing.
Call 1: reach the right department
"I'm calling about account [account number] for care on [dates]. I want to resolve the balance, and I need the hospital's financial-assistance or charity-care policy and application. Please tell me which department handles the application, the deadline, the documents required, and what happens to the account while the application is reviewed."
If the first representative points you back to a generic billing line, ask for the department name, direct number, mailing address, secure upload route, and a reference number. The goal is to give the application a visible owner.
Call 2: protect the account while the application is pending
"I am gathering the documents for financial assistance on account [account number]. Please note that the application is pending or being prepared. What payment arrangement can I maintain while the review is open, and will the account remain with the hospital during the review? Please send the answer and the next due date in writing."
A payment arrangement is a financial choice. Ask only for an amount you can maintain. If the balance is later reduced, request a statement that identifies the adjustment and the remaining amount. If a collector already holds the account, CMS advises patients to tell the collector that financial assistance is being pursued and ask for a written pause while the application is reviewed. 2
Appeal after a denial
"I am appealing the decision on account [account number]. Please send me the written reason for the denial, the policy section used, the appeal deadline, and the exact documents or corrections required. I am attaching [list of documents]. Please confirm receipt, tell me the name of the person or department reviewing the appeal, and keep the account review status in writing while the appeal is pending."
Send the appeal through the method the policy accepts. Keep a copy of the complete package. If the policy uses a form, use the form and attach a short cover letter that lists every enclosure. If the hospital says the appeal is incomplete, ask it to identify the missing item specifically.
Verify forgiveness or a refund
"I received a notice that account [account number] was reduced or forgiven. Please confirm the final balance, the service dates covered, whether the adjustment is payment in full, and whether payments already made will be refunded. Please send the revised statement and refund details in writing."
Jose called the finance company because he wanted to confirm that the refund was really his. That verification step matters. Do not rely on a phone assurance when the account portal, revised statement, or written approval says something different. Save the approval letter, final statement, and refund record together. 1
If the appeal does not solve the balance
A denial is a decision on one application. It is a reason to obtain the policy section and the next available route. Ask whether the hospital accepts an appeal, a corrected application, a new application after a change in income, or a hardship review. Ask whether separate physician, anesthesia, radiology, pathology, ambulance, or laboratory accounts use separate policies.
CMS recommends asking for a detailed bill, comparing it with medical records, checking duplicate charges, and checking that billing codes describe the care received. If an item does not match your records, send the billing department the specific line and the record that supports your question. 4
If insurance was active on the date of service, compare the bill with the explanation of benefits, or EOB. CMS says an EOB is not a bill; it lists provider charges, allowed charges, insurer payment, and the patient's balance. When the provider bill and EOB disagree, contact both the insurer and provider. 5
If the balance is valid and every assistance route is exhausted, ask the provider for an affordable payment plan and get its terms in writing. Ask whether the plan is interest-free, which account it covers, whether the account stays out of collections while you pay as agreed, and what happens if your income changes. A payment plan is a way to resolve a balance; it is not a reason to put an unreviewed bill on a credit card or to stop answering the provider.
Patients who want help with the paperwork can look for a nonprofit patient-advocacy service or a state Consumer Assistance Program. CMS directs patients with billing problems to state consumer assistance and patient advocates, and its complaint page provides another official route when the problem remains unresolved. 46
First 3 Moves: within 72 hours of any US medical bill
These actions apply to an ER visit, surgery, imaging, a specialist appointment, an ambulance, a laboratory account, or an outpatient procedure. They preserve time for review while you continue communicating about any valid balance.
1. Request the complete itemized bill
Use the account number on the first invoice. Ask for service dates, billing codes, units, individual charges, adjustments, payments, and the current patient balance. Ask whether separate accounts exist for the facility, physician, anesthesia, radiology, pathology, laboratory, or ambulance.
"Please send me the complete itemized bill for account [account number], including service dates, billing codes, units, charges, payments, adjustments, and the current patient balance. Please identify any separate provider accounts connected with this care."
CMS recommends requesting a detailed bill and comparing it with your medical records. It also recommends checking for duplicate charges and checking that the billing codes match the care you received. 4
2. Do not pay the first invoice before checking the bill and EOB
The first invoice is a request for payment, not a substitute for checking the account. Compare the itemized bill with your records. If insurance covered the service, compare the bill with the EOB and the claim number. CMS says the EOB is not a bill and that the provider bill should match the patient-balance amount shown there. 5
If the due date is near, call the provider and ask for a written extension, review status, or payment arrangement. Use this wording:
"I am reviewing the itemized bill and EOB, and I am working to resolve any valid balance. Please tell me the next deadline and confirm any extension, account review, or payment arrangement in writing."
3. Check financial-assistance eligibility
Search the hospital's name with "financial assistance" or "charity care," or ask billing for the written policy. CMS says eligible patients at nonprofit hospitals must have access to financial assistance, and the policy should explain eligibility, how to apply, deadlines, required contacts, and what happens while an application is pending. 2
"Please send me the hospital's written financial-assistance policy and application. Please list the eligibility rules, deadline, required documents, contact person, and what happens to account [account number] while the application is reviewed."
Submit the application through the accepted channel and save proof of delivery. Ask when to follow up. If the hospital denies the application, request the written reason and appeal instructions before closing the file.
The result to copy is the process, not the promise
Jose's $5,700 additional bill reached zero after a denial, an appeal, and a final verification call. His case gives a financially stressed patient a route that is specific enough to try: ask about financial assistance even when the first payment plan is already in place, collect the requested records, appeal in writing, and confirm the final balance and any refund.
The case does not establish Jose's insurance status, the reason for the first denial, or a guaranteed outcome for another patient. It also does not make a TikTok tip a substitute for the hospital's policy. The durable step is to find the department that owns the account, create a written trail, and keep the file moving until the provider gives you a final answer.
If the account remains valid after review, choose a payment plan you can maintain and keep the terms in writing. The goal is a resolved medical bill that does not force a family to choose between care, food, and an avoidable paperwork gap.
This article is educational information, not legal, medical, insurance, or financial advice. Financial-assistance policies, deadlines, collection practices, and payment options vary by provider and state.
References
- 1Jose – Dollar For
dollarfor.org
- 2
- 3Charity Care Handbook
dollarfor.org
- 4
- 5
- 6CMS: Submit a complaint
cms.gov
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