Colorado has enacted some of the nation’s strongest medical billing protections, including a first-of-its-kind facility fee ban at off-campus outpatient clinics under HB 22-1285 and a robust charity care program covering patients up to 350% of the Federal Poverty Level. Despite these protections, BillKarma’s analysis of 500+ Colorado hospitals found that the median markup over Medicare is 3.8× — and that facility fees continue to appear on bills from off-campus clinics in violation of state law. This guide explains every protection available to Colorado patients and how to use them.
1. Colorado’s facility fee ban (HB 22-1285)
House Bill 22-1285, signed into law in 2022 and effective January 1, 2023, makes Colorado one of the first states in the nation to ban facility fees at off-campus hospital outpatient departments. Facility fees — separate charges that hospitals add on top of the physician’s professional fee simply for using a hospital-owned location — can add $250 to $2,000+ to a routine office visit. HB 22-1285 eliminates this practice at off-campus sites.
Key provisions of HB 22-1285:
- Off-campus facility fee ban. Hospitals may not charge a facility fee for services provided at an off-campus outpatient location. “Off-campus” means any location that is not on the main hospital campus or within 250 yards of it.
- Patient notification requirement. For on-campus outpatient departments where facility fees are still permitted, hospitals must notify the patient in writing before the visit that a facility fee will be charged, the estimated amount, and that the patient may be able to receive the same service at a lower cost at an independent physician’s office.
- No retroactive billing. If a hospital fails to provide the required written notice before an on-campus visit, it cannot charge the facility fee for that visit.
- Enforcement. Violations can be reported to the Colorado Division of Insurance. The Colorado Attorney General also has authority to investigate deceptive billing practices under the Colorado Consumer Protection Act.
2. Charity care and the Hospital Discounted Care Program
Colorado’s Hospital Discounted Care Program (HDCP) requires all hospitals in the state — both nonprofit and for-profit — to provide financial assistance to qualifying patients. The program is codified in Colorado Revised Statutes § 25.5-3-501 and administered by the Colorado Department of Health Care Policy and Financing (HCPF).
Key eligibility rules:
- Free care at or below 250% FPL. Uninsured patients with household income at or below 250% of the FPL receive 100% write-off of hospital charges.
- Sliding-scale discounts from 250% to 350% FPL. Patients above 250% but at or below 350% FPL receive discounts on a sliding scale. The discount decreases as income rises.
- Retroactive application. You can apply for HDCP within 240 days of the first billing statement, even if you have already made payments.
- Insured patients may qualify. If you have insurance but face high out-of-pocket costs, you can apply for HDCP assistance on the patient responsibility portion of your bill.
- All Colorado hospitals must participate. This is not voluntary. Every licensed hospital in Colorado must comply with the HDCP.
| Household Size | 100% FPL (2026) | 250% FPL (free care) | 350% FPL (max for discount) |
|---|---|---|---|
| 1 person | $15,650 | $39,125 | $54,775 |
| 2 people | $21,150 | $52,875 | $74,025 |
| 3 people | $26,650 | $66,625 | $93,275 |
| 4 people | $32,150 | $80,375 | $112,525 |
| 5 people | $37,650 | $94,125 | $131,775 |
| 6 people | $43,150 | $107,875 | $151,025 |
Note: FPL figures are updated annually each February. The numbers above reflect 2026 HHS guidelines. Confirm current thresholds at aspe.hhs.gov before applying.
Not sure if you qualify? Check your hospital’s charity care policy and markup rate in our Colorado hospital directory — find your Colorado hospital’s billing grade and see how their charges compare to Medicare.
Use our charity care eligibility tool to check your household’s eligibility and get a pre-filled application.
3. Surprise billing protections
Colorado was ahead of most states in addressing surprise medical billing. The Out-of-Network Consumer Protection Act, signed in 2019 and effective January 1, 2020, protects patients from balance billing in many situations — predating the federal No Surprises Act by two years.
Here is how Colorado’s law and the federal NSA work together:
| Protection | Colorado Law (2020) | Federal No Surprises Act (2022) |
|---|---|---|
| Emergency services | Patients pay in-network cost-sharing only; no balance billing by OON providers | Same protection; applies to all plan types |
| Non-emergency at in-network facility | OON providers cannot balance bill if patient had no choice (ancillary providers like anesthesiologists, radiologists, pathologists) | Same protection; covers ancillary and some additional provider types |
| Consent exception | OON provider may balance bill only with written consent given 72 hours in advance | Similar; written consent required with specific disclosures |
| Payment dispute resolution | Colorado uses an arbitration process through the Division of Insurance | Independent Dispute Resolution (IDR) process at federal level |
| Air ambulance | Not covered under state law | Covered under NSA; no balance billing for OON air ambulance |
| Self-funded employer plans | Not covered (ERISA preemption) | Covered under NSA |
Which law applies? For state-regulated plans (individual, small group, and fully insured large group plans), Colorado’s law applies. For self-funded employer plans, the federal NSA applies. In many cases, both laws provide similar protections — Colorado patients benefit from whichever offers stronger coverage for their situation.
If you receive a surprise bill from an out-of-network provider, upload it to BillKarma — we identify balance billing violations under both Colorado law and the federal NSA, then generate a dispute letter you can send immediately.
4. Medical debt and credit reporting in Colorado
Colorado provides multiple layers of protection for patients facing medical debt:
Credit reporting restrictions
- Medical debt under $500 cannot be reported. Colorado law (effective 2023) prohibits reporting medical debt under $500 to any consumer reporting agency.
- National credit bureau changes. The three major credit bureaus (Equifax, Experian, TransUnion) voluntarily removed all paid medical debt and medical debt under one year old from credit reports starting in 2023. Medical debt under $500 was also removed.
- Combined effect: In Colorado, medical debt under $500 is protected by state law, and debt under one year old is protected by bureau policy. This means most small medical debts will never appear on your credit report.
Wage garnishment limits
Colorado follows federal garnishment limits with additional state protections:
- Garnishment is limited to 25% of disposable earnings or the amount by which weekly earnings exceed 40 times the federal minimum wage, whichever is less.
- A creditor must first sue you and obtain a court judgment before any garnishment can begin.
- Head-of-household exemptions may further reduce the garnishable amount.
- Under the Colorado Consumer Protection Act, collectors who use deceptive practices in pursuing medical debt can face penalties and be required to pay the patient’s attorney fees.
Colorado Consumer Protection Act
The Colorado Consumer Protection Act (CRS § 6-1-105) prohibits deceptive trade practices in debt collection. Medical billing practices that violate this law include: billing for services not rendered, misrepresenting the amount owed, threatening legal action the collector does not intend to take, and failing to provide proper validation of the debt. Patients can file complaints with the Colorado Attorney General.
5. Statute of limitations on medical debt in Colorado
Understanding Colorado’s statute of limitations (SOL) on medical debt is critical — once the SOL expires, collectors cannot win a lawsuit against you. Use our statute of limitations lookup tool to check the status of your specific debt.
| Debt Type | Colorado SOL | Notes |
|---|---|---|
| Written contract (signed financial agreement) | 6 years | Applies if you signed a payment plan or financial responsibility form |
| Open account (no signed contract) | 3 years | Most hospital bills without a signed agreement fall here |
| Promissory note | 6 years | Rare in medical billing contexts |
| Judgment (after collector wins lawsuit) | 20 years (renewable) | Responding to lawsuits is critical — never ignore a summons |
What resets the SOL in Colorado:
- Making any payment on the debt restarts the clock from the date of that payment.
- Written acknowledgment of the debt (including in writing or email) can restart the clock.
- Tolling: The SOL may be paused (tolled) if you leave Colorado for an extended period. Under CRS § 13-80-111, periods during which the debtor is absent from the state are excluded from the limitations period.
Important: Even after the SOL expires, collectors may still contact you and ask for payment. They cannot, however, win a lawsuit against you. If a collector sues you on time-barred debt, you must raise the SOL as an affirmative defense in your answer — the court will not do it automatically.
6. How to dispute a Colorado hospital bill
Step 1: Request an itemized bill
Call the hospital billing department and request a complete itemized statement showing every CPT code, revenue code, description, unit price, and quantity billed. Put the request in writing (email or letter) so you have a dated record. Colorado patients have the right to receive an itemized bill upon request.
Step 2: Check for facility fee violations
Look for any charge labeled “facility fee,” “hospital outpatient department fee,” or revenue codes 0510–0529. If the service was provided at an off-campus location, this charge likely violates HB 22-1285. Even for on-campus visits, verify that the hospital provided written notice of the facility fee before your appointment.
Step 3: Compare charges to Medicare rates
Use our free calculator to look up the Medicare benchmark for each CPT code on your bill. Any charge above 5× the Medicare rate is a significant red flag. Colorado hospitals average 3.8× Medicare — charges well above that deserve scrutiny.
Step 4: Apply for HDCP charity care if eligible
If your household income is at or below 350% FPL, apply for the Hospital Discounted Care Program. Ask the billing department for the HDCP application — every Colorado hospital is required to have one available. Submit income documentation (pay stubs, tax return, bank statements) with your application.
Step 5: Submit a written dispute
Write a dispute letter to the hospital billing department. Include: your account number, date of service, each line item you are disputing, the reason for each dispute (with citations to HB 22-1285 for facility fees, HDCP rules for charity care, or specific billing errors), and any supporting documentation. Send by certified mail with return receipt requested.
Step 6: File a complaint if the dispute is ignored
If the hospital does not respond within 30 days or refuses to correct an error:
- Facility fee violations or surprise billing: File a complaint with the Colorado Division of Insurance
- Deceptive billing practices: File a complaint with the Colorado Attorney General
- No Surprises Act violations: File with the CMS No Surprises Help Desk (1-800-985-3059)
- HDCP charity care denial: Contact the Colorado HCPF to report the hospital’s failure to comply with the HDCP
7. Annotated Colorado hospital bill
The following example shows an outpatient visit at a Colorado hospital-owned clinic with three common billing problems: an illegal facility fee at an off-campus location, an upcoded E&M level, and charges well above Medicare benchmarks.
What to do with each problem on this bill:
- Illegal facility fee ($680): This off-campus clinic is 3 miles from the hospital campus, making the facility fee a direct violation of HB 22-1285. Write a dispute letter citing the law and demand a full refund. If the hospital refuses, file a complaint with the Colorado Division of Insurance.
- Upcoded office visit ($420): Request your visit notes and compare them to the E&M coding requirements. A routine follow-up visit is typically a 99213 ($110 Medicare) or 99214 ($165 Medicare), not a 99215 ($225 Medicare). Dispute the upcode with medical records as evidence.
- Lab charges above Medicare ($240 for CMP): Medicare pays approximately $14 for a comprehensive metabolic panel (80053). A charge of $240 is a 17× markup. While not illegal, this extreme markup strengthens your case for a charity care discount or negotiated reduction.
8. Real patient results
Case study 1: $2,040 facility fee refund under HB 22-1285 — Denver
Situation: A patient in Denver visited a hospital-owned orthopedic clinic for three follow-up appointments over six months in 2025. Each visit included a $680 facility fee in addition to the physician’s professional fee. The clinic was located in a medical office building 2.5 miles from the main hospital campus.
Patient profile: Insured through employer plan, $3,000 deductible not yet met. The facility fees were applied entirely to the patient’s deductible.
Action: After the third visit, the patient uploaded all three bills to BillKarma. The system flagged the facility fees as potential HB 22-1285 violations because the clinic address was more than 250 yards from the main hospital campus. The patient sent a dispute letter citing HB 22-1285 and requesting refunds for all three facility fees. When the hospital did not respond within 30 days, the patient filed a complaint with the Colorado Division of Insurance.
Result: The Division of Insurance contacted the hospital, which confirmed the clinic was an off-campus location. The hospital refunded all three facility fees ($2,040 total) and adjusted its billing system to stop charging facility fees at that location.
Savings: $2,040.
Case study 2: $14,200 ER bill reduced to $0 through HDCP charity care — Colorado Springs
Situation: A single mother of two in Colorado Springs was taken to the emergency room after a car accident. She had no insurance and received a $14,200 bill for X-rays, a CT scan, pain management, and wound care.
Patient profile: Household of 3, annual income $48,000 — approximately 180% of FPL. Well below the 250% FPL threshold for free care under the HDCP.
Action: The patient contacted the hospital billing department and asked about financial assistance. The hospital provided the HDCP application, but the patient found the paperwork confusing and did not submit it for two months. BillKarma helped her complete the application with the required income documentation (two recent pay stubs and prior year’s tax return) and submit it before the 240-day deadline.
Result: The hospital approved the HDCP application and wrote off the entire $14,200 bill. The patient’s income at 180% FPL was well within the free-care threshold. No payment plan required.
Savings: $14,200.
Case study 3: $4,800 surprise anesthesiology bill eliminated — Aurora
Situation: A patient in Aurora underwent an outpatient knee arthroscopy at an in-network surgical center. The surgeon and facility were both in-network. Six weeks after the procedure, the patient received a separate $4,800 bill from the anesthesiologist’s group, which was out-of-network. Insurance paid $1,900 based on the allowed amount, and the anesthesiologist billed the patient $2,900 as the “balance.”
Action: The patient submitted a dispute citing Colorado’s Out-of-Network Consumer Protection Act and the federal No Surprises Act, noting that the anesthesiologist was an ancillary provider at an in-network facility and the patient had no meaningful choice. The patient also filed a complaint with the Colorado Division of Insurance. The Division confirmed that balance billing was prohibited in this scenario.
Result: The anesthesiologist’s group withdrew the $2,900 balance bill within 21 days of the Division’s inquiry. The patient’s total liability was limited to their in-network copay of $150.
Savings: $2,900.
Frequently asked questions
Does Colorado ban facility fees at outpatient clinics?
Yes. Under HB 22-1285 (effective January 1, 2023), Colorado prohibits hospitals from charging facility fees at off-campus outpatient locations — any site not on the main hospital campus or within 250 yards of it. For on-campus outpatient departments, hospitals must provide written notice of the facility fee before the visit, including the estimated amount and alternatives. If you see a facility fee on a bill from an off-campus clinic, it is likely illegal. Upload your bill to check automatically.
What is the income limit for charity care at Colorado hospitals?
Under Colorado’s Hospital Discounted Care Program (HDCP), all hospitals must provide free care to uninsured patients at or below 250% FPL — approximately $39,125 for a single person or $80,375 for a family of four in 2026. Patients between 250% and 350% FPL ($54,775 single / $112,525 family of four) qualify for sliding-scale discounts. Both nonprofit and for-profit hospitals must participate.
What is the statute of limitations on medical debt in Colorado?
Colorado has a 6-year SOL for written contracts (signed payment agreements or financial responsibility forms) and a 3-year SOL for open accounts (most hospital bills without a signed contract). The clock starts from the date of the last payment or the date the debt became delinquent. Be aware that leaving Colorado may toll (pause) the SOL clock, and any payment restarts it. Use our SOL lookup tool to check your debt’s status.
Does Colorado protect patients from surprise medical bills?
Yes. Colorado’s Out-of-Network Consumer Protection Act (2019) prohibits balance billing for emergency services and for non-emergency services at in-network facilities when the patient had no meaningful choice of provider. The federal No Surprises Act provides additional coverage for self-funded employer plans and air ambulance services. If you receive a surprise bill, file a complaint with the Colorado Division of Insurance.
Can Colorado hospitals report medical debt under $500 to credit bureaus?
No. Colorado law prohibits reporting medical debt under $500 to credit bureaus. Combined with the national credit bureau policy changes in 2023 (removing all paid medical debt and debt under one year old), most small medical debts in Colorado will never appear on your credit report. If a collector reports medical debt under $500, file a complaint with the Colorado Attorney General.
Sources
- Colorado HB 22-1285: Facility Fee Transparency and Restrictions
- Colorado HCPF: Hospital Discounted Care Program (HDCP)
- Colorado Division of Insurance: File a Health Insurance Complaint
- Colorado Attorney General: File a Consumer Complaint
- CMS: No Surprises Act Overview and Patient Rights
- CFPB: Medical Debt Resources for Consumers
- Colorado Out-of-Network Consumer Protection Act (HB 19-1174)