Charlotte Hospital Bill Help 2026–27: Atrium and Novant Charity Care, Step by Step
Most people in Charlotte who get a large hospital bill end up dealing with one of two systems: Atrium Health or Novant Health. Both have written financial assistance policies, and both cover patients with household income at or below 300% of the federal poverty guidelines (FPG). Many people who qualify never apply because they assume charity care is only for people with no income at all. It isn't.
This guide covers what each system offers, the statewide changes North Carolina made to hospital billing, what papers to gather, and the mistakes that get applications stalled.
Last checked October 2026. Facts come from Atrium Health's and Novant Health's published financial assistance pages and policies, and from the NC Department of Health and Human Services (NCDHHS). Hospital policies change, so confirm the current version before you apply. This is general information, not legal or financial advice.
First, Three Things to Know
"Charity care" and "financial assistance" mean the same thing here. Hospitals use the term financial assistance on bills and websites.
You can usually apply after the bill arrives. You don't have to have applied before treatment.
Insurance doesn't automatically rule you out. NCDHHS says most of the new North Carolina hospital protections apply to both uninsured and insured patients with incomes at or below 300% FPL.
Atrium Health: What the Policy Says
Atrium Health's financial assistance page lays out the income tiers:
Household income at or below 300% FPG: 100% financial assistance.
Household income between 301% and 400% FPG: partial assistance.
Atrium also lists several programs that sit alongside regular financial assistance:
Uninsured Discount. Uninsured patients get 50% off gross charges on all medically necessary services. Atrium says this is applied automatically.
Financial Assistance Scoring (FAS). For uninsured residents of North Carolina, South Carolina, Georgia, or Alabama who had hospital outpatient or medical group services. Atrium reviews lower-balance outpatient accounts automatically, using third-party scoring. Accounts that qualify get 100% assistance and no bill. If your account doesn't qualify, you'll get a letter and can still file a full application.
Hardship Discount Program. For people who had a catastrophic medical event and don't qualify on income. Atrium says the remaining balance must be greater than 10% of total household income. Atrium asks you to call customer service after you receive your first statement to ask about it.
Community Sliding Fee Discount Program. At NHSC-approved sites, with discounts based on family size and income.
How to apply to Atrium:
Online through your MyAtriumHealth account (you can sign up if you don't have one).
By mail. Download the application from Atrium's financial assistance page and mail it to the PO box listed on the form (Charlotte, NC 28232-2861).
By phone at 704-512-7171 (Atrium also lists 844-440-6536).
In person at the hospital's admitting office.
If you're uninsured and have a large balance, Atrium says its financial counselors will first help check you for other coverage, such as Medicaid. If you cooperate and no coverage is available, you're then evaluated for financial assistance. Don't skip the Medicaid step. It can hold up the charity care decision.
Novant Health: What the Policy Says
Novant's North Carolina hospital policy covers all Novant hospitals and provider-based clinics in the state. Key points from the policy and Novant's plain-language summary:
Family income must be no more than 300% of the current Federal Poverty Guidelines.
It covers emergency and medically necessary services. It does not cover elective services.
Uninsured patients who qualify get a 100% adjustment of covered charges.
The policy lists discount tiers by income: 100% below 200% FPL, 75% between 200% and 250%, and 50% between 250% and 300%.
Novant's summary also lists conditions, including that you:
live in the Novant Health service area;
can't get other programs that would cover the bill;
don't have substantial cash assets;
didn't decline health insurance offered through an employer; and
turn in the application and supporting documents.
How to apply to Novant:
By mail to Novant Health, ATTN: Financial Assistance, PO Box 11549, Winston-Salem, NC 27116.
In person at the Financial Counseling office of any Novant hospital, where staff can help you fill out the form.
By phone at 1-844-266-8268, option 3, to have the policy and an application mailed to you.
Through MyChart.
North Carolina's Medical Debt Initiative
In 2024, NCDHHS started a medical debt initiative with North Carolina hospitals. NCDHHS says that at participating hospitals:
Since January 1, 2025, you automatically qualify for charity care if you're enrolled in a public benefit program like SNAP or WIC, if you're experiencing homelessness, or if you or anyone in your household is enrolled in Medicaid.
Hospitals agreed to work with Undue Medical Debt (or another nonprofit partner) to relieve certain old medical debt.
If your debt was relieved, you'll get a letter by mail from the hospital or from Undue Medical Debt. NCDHHS says you don't have to do anything to get relief and won't be asked to pay any fees.
Watch for scams. Because the relief is automatic and free, anyone who calls asking for a fee to "get your debt forgiven" isn't part of this program. Hang up and call the hospital's billing number from your statement.
Ask directly. Not every hospital or every bill is covered in the same way. When you call, ask: "Is this hospital participating in the NCDHHS medical debt initiative, and does my account qualify for presumptive charity care?"
Documents to Have Ready
Gather these before you call or fill out a form:
The bill or statement, with the account number.
Photo ID.
Proof of income for everyone in the household. Novant's application lists paycheck stubs, last year's tax return, or a letter from your employer with your current pay and hours.
Proof of benefits if you get SNAP, WIC, or Medicaid, such as an approval letter.
Insurance cards and any Explanation of Benefits (EOB) letters if you're insured.
Job loss details if it's recent. Novant's application asks about unemployment within the last 90 days, the employer's name, and COBRA.
A list of everyone in your household, with ages.
Step-by-Step: From Bill to Decision
Step 1: Don't pay the full bill yet. Paying first and asking later makes refunds harder.
Step 2: Ask for an itemized bill. Check dates, services, and duplicate charges.
Step 3: Call the billing number on the statement. Say you want to apply for financial assistance. Ask whether your account is being held from collections while your application is reviewed, and write down the name of the person you spoke with.
Step 4: Apply with everything at once. Missing income papers are the most common reason applications stall.
Step 5: Keep copies. Take photos of every page before mailing, or upload through the patient portal so there's a record.
Step 6: Follow up in two to three weeks. If you haven't heard anything, call back and ask about the status.
Step 7: If you're denied, ask why in writing. Ask whether the hardship or catastrophic program applies, and whether a payment plan is available while you appeal.
Common Mistakes
Only applying to the hospital. Doctors, anesthesiologists, and ambulance companies often bill separately. Ask each one about its own policy.
Using last year's income when this year is lower. Tell the counselor if your income dropped. Bring proof of the change.
Ignoring the Medicaid screening. North Carolina expanded Medicaid, and many adults who didn't qualify before may now. Charity care decisions can wait until Medicaid is ruled out.
Assuming insurance disqualifies you. Copays, deductibles, and coinsurance may still be eligible.
Putting the bill on a credit card. Once it's a card balance, the hospital's assistance programs can't reduce it.
Missing letters. Open all hospital mail. A denial or a request for more documents usually comes with a deadline.
FAQ
Do I have to be uninsured to get charity care in Charlotte? No. NCDHHS says most of the new hospital protections apply to insured and uninsured patients with incomes at or below 300% FPL. Each hospital's policy sets exactly what's covered.
What does 300% of the federal poverty guidelines mean in dollars? It depends on household size and changes each year. Ask the financial counselor to check your household size and income against the current year's figures.
Does Novant cover elective procedures? No. Novant's policy covers emergency and medically necessary services, not elective services.
I got a letter saying my debt was relieved. Is it real? NCDHHS says relief letters come from the hospital or from Undue Medical Debt, and you won't be asked to pay a fee. If you aren't sure, call the hospital billing office using the number on an old statement.
I make too much for Atrium's income tiers, but the bill is huge. Is there any help? Ask about Atrium's Hardship Discount Program. Atrium says the remaining balance must be more than 10% of your household income.
Can I get help filling out the form? Yes. Both systems have financial counselors at their hospitals.
Related Guides
Sources
Atrium Health, Financial Assistance: https://atriumhealth.org/for-patients-visitors/financial-assistance
Novant Health, Financial Assistance: https://www.novanthealth.org/for-patients/billing--insurance/financial-assistance/
Novant Health, NC Hospitals Financial Assistance Policy: https://www.novanthealth.org/globalassets/buttons-and-documents-ctaslinks/documents-pdfs/policy-nc-hospitals-financial-assistance.pdf
Novant Health, plain-language summary: https://www.novanthealth.org/globalassets/buttons-and-documents-ctaslinks/documents-pdfs/novant-health-acute-pls-english.pdf
Novant Health, Financial Assistance Application: https://www.novanthealth.org/globalassets/buttons-and-documents-ctaslinks/documents-pdfs/faa_app_english.pdf
NCDHHS, NC Medical Debt: https://www.ncdhhs.gov/medicaldebt
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