Share Your Hospital Bill Story Have you, a friend, or a family member needed hospital care without health insurance or using Medicaid? Share your story here! We will use your story to talk to advocates and policymakers about improving New York's financial assistance laws. When you tried to get hospital care, did you have insurance?* No, I did not have insurance. Yes, Medicaid. Yes, some other type of insurance. If you did not have insurance, did the hospital inform you that you could be eligible for financial assistance?Yes.No.Not applicable.If you ended up with a hospital bill you could not afford, did the hospital take any of the following steps?The hospital told me that I might be eligible for financial asssitance.The hospital gave me an application for financial assistance.The hospital told me there was nothing they could do.The hospital put me on a payment plan.What happened after you said you could not pay your hospital bill? Was it easy to get an application for financial assistance? Was it easy to fill out?What was the outcome? Were you able to pay your bill? How did the bill affect your health or other areas of your life?Can we publish your story online? Yes No If yes, can we include any of the following information? First name Your town or city Your county Thank you for sharing your story! Please provide your contact information below - we will be in touch to make any clarifications and talk more about how we can use your story. Your contact information will be kept confidential.Name First Last Location City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone Δ
