Financial Assistance Policy

1. It is the policy of HSC Medical Center to provide financial assistance for medically necessary services to the uninsured and underinsured based on the patient's ability to pay. Approval for financial assistance will be based on information obtained from the patient and/or other agencies when available.

2. Eligibility for full or partial financial assistance will be based on the current Federal Poverty Guidelines, as set forth on the sliding scale attached as Appendix A. However, annual household income may not be the only factor considered when determining eligibility for financial assistance. Other factors that may be considered include net worth, employment status and earning capacity, family size, amount and frequency of needed healthcare services, other sources of payment for the services rendered, and other financial obligations.

3. Patients who do not provide the requested information necessary to completely and accurately assess their financial situation in a timely manner and/or who do not cooperate with efforts to secure governmental healthcare coverage may not be eligible for financial assistance.

4. Financial assistance may be granted prospectively or retrospectively. All persons applying for or receiving financial assistance will be treated with dignity and respect. All overdue accounts will be reviewed internally to determine whether the patient is eligible for financial assistance prior to initiation of any external collection efforts, legal proceedings, or other extraordinary collection efforts.

5. Discounts will be applied as payments are received in accordance with the sliding scale.

6. This Financial Assistance Policy applies only to medically necessary services and does not include physician or professional charges that are not billed by the Hospital or elective procedures for which no evidence of medical necessity can be determined.

7. The Hospital will take reasonable measures to assure that patients are made aware of the existence of this Financial Assistance Policy. Employees in the scheduling, patient access, patient financial services and emergency departments will be fully versed in this policy, have access to the financial assistance application forms, and be able to direct questions to the appropriate HSC Medical Center representatives. Patients will be provided with information about financial assistance upon request, including specific information as to how eligibility is determined and the method of applying for assistance.

8. Notices of this Financial Assistance Policy will be posted on the Hospital's Website and in several prominent locations within the Hospital, such as the emergency department, billing office, and registration areas. The notices will be clearly visible to the public.

9. Patients who may qualify for financial assistance from a governmental program, such as Medicaid, will also be provided with information on such programs. Insured patients who qualify for financial assistance may be eligible for financial assistance for deductible balances.

10. Patients who are eligible for financial assistance will not be charged for emergency or other medically necessary care at rates higher than the amounts generally billed to third-party payers. The use of gross charges to such patients is prohibited.

11. In the event a patient approved for financial assistance fails to comply with payment terms for a period of more than 121 days, the account may be turned over to a collection agency in accordance with the Hospital's Collection Policy. Any collection agencies used by the Hospital will agree to refrain from abusive collection practices.

12. This policy will be applied equally to all patients regardless of payer. Applications that do not meet established criteria may be approved based upon extraordinary circumstances with the documented approval of the CEO.

13. Applications for charity care will be reviewed within thirty (30) days of receipt of a completed application. Patients will be notified of the Hospital's eligibility determination in a timely manner.

14. Approved financial assistance will be in effect six months prior to and six months after the date of approval. Services provided later than six months after approval will be subject to a renewal application. All applications for charity care will be maintained for a period of six months.

15. The cost of financial assistance will be reported annually on Form 990. Charity Care will be reported as the cost of care provided and will not include bad debt.

16. This policy will be reviewed annually to determine appropriateness to current community and financial conditions. Policy revisions must be approved by the Board of Directors.

Procedure:

1. The Hospital's Financial Assistance Policy will be widely publicized. Any patient who requests information about this policy or requests an application will be provided with such. Any patient who informs Hospital personnel that he or she cannot afford to pay for services will be provided with information about this policy or referred to appropriate Hospital personnel who can provide assistance.

2. Patients with overdue account balances will be evaluated for eligibility for financial assistance before the account is turned over to a collection agency or any extraordinary collection actions are taken. For patient's who have expired with open account balances, a Hospital Financial Counselor will perform an investigation to attempt to determine whether the patient would have qualified for financial assistance before collection efforts are undertaken.

3. The Financial Counselor or Self-Pay Collector will assist individuals with obtaining and completing financial assistance applications. Applications may be obtained from the Financial Counselor, Self Pay Collector or Patient Financial Services Department upon request.

4. Information obtained from the Department of Human Services may be used to assist in determining eligibility for financial assistance if the patient is unable to complete an application.

5. Patients presenting as homeless/indigent, who have not completed an application, may be considered for financial assistance based on information documented at the time of service.

6. Except in extraordinary circumstances, to be eligible to receive financial assistance, the following criteria must be met:

a. The patient must apply for Medicaid assistance and/or disability. In cases where the patient has active Medicaid/Medicare that will not cover the entire bill, it will not be necessary to complete a new application for Medicaid. Examples include QMB, SMB, or OB services.
b. The patient has stated he or she does not have the financial means to pay the amount owed.
c. The Patient is not eligible for any other resources such as contracts for MHU patients, or any government assistance programs for certain diagnosis such as TB or HIV.
d. No insurance coverage is available to cover the amount owed.
e. No available credit for payment.
f. The patient provides a complete and accurate application for financial assistance.
For patients who owe an extraordinary balance that is catastrophic to the family income base, catastrophic protection may be provided by limiting payment liability to 100 percent of annual household income. Determinations to provide catastrophic financial assistance will be made by the CEO.
7. The following information should be included with the application for financial assistance:

a. A copy of the patient's most recent income tax return.
b. A copy of the patient's last 3 check stubs (showing gross income), if available, or a letter from the employer stating the patient's income.
c. A Medicaid denial from the Department of Human Services.
d. Reasonable proof of declared assets and expenses listed on the financial assistance application.
e. Permission to allow HSC Medical Center to complete a credit report.

8. Once a patient has submitted required information, the Financial Counselor will review and analyze the application as follows:

a. Perform a credit report on the applicant.
b. Verify assets with County Assessors Office.
c. Once all information has been verified and approved, the application will be forwarded to Administration for final approval by signature.
d. If the application is denied, the patient will be notified by letter of the denial and will be expected to begin payment on the account.
e. Once final approval has been obtained, the application will be sent to the Director of Patient Financial Services for adjustment.
f. Applications will be returned to the Financial Counselor for filing and notifying patients of the amount of financial assistance for which they quality.
g. Documentation of the final determination will be made on the patient’s account.
h. Eligibility for financial assistance will remain valid for a period of six (6) months.
i. If the patient receives proportional assistance, he/she must agree to an approved payment schedule to repay any remaining balance.
NOTE: Applications that do not meet established criteria may be approved based on extraordinary circumstances with the documented approval of Hospital Administration.
A copy of the application is attached to this policy

Sliding Scale

1. The following sliding scale, based on the Federal Poverty Guidelines, will be used to determine the amount of financial assistance for which a patient qualifies; provided, however, in addition to income and family size, the following factors may be considered when determining the amount of financial assistance for which a patient is eligible.

a. Net worth
b. Employment status and earning capacity
c. Amount and frequency of bills for healthcare services
d. Other sources of payment for the services rendered
e. Other financial obligations
f. Catastrophic or extraordinary circumstances

Income ? 200% Federal Poverty Level = 100% Discount
Income from 201-225% Federal Poverty Level = 80% Discount
Income from 226-250% Federal Poverty Level = 60% Discount
Income from 251-275% Federal Poverty Level = 40% Discount
Income from 276-300% Federal Poverty Level = 20% Discount

 

 

 

                                                              APPENDIX A
                    HSC Medical Center Financial Assistance Program Guidelines---2011

                                                                     

# Persons in the Family

2011 Poverty Level Guidelines for Annual Household Income

 

    < 200%          201-225%              226-250%               251-275%               276-300%

 

1

 ≤ $21780

$21781-24502

$24503-27225

$27226-29947

$29948-32670 

 

2

≤ $29420

$29421-33097

$33098-36775

$36776-40452

$40453-44130 

 

3

≤ $37060

$37061-41692

$41693-46325

$46326-50957

$50958-55590 

 

4

≤ $44700

$44701-50287

$50288-55875

$55876-61462

$61463-67050 

 

5

≤ $52340

$52341-58882

$58883-65425

$65426-71967

$71968-78510 

 

6

≤ $59980

$59981-67477

$67478-74975

$74976-82472

$82473-89970 

 

7

  ≤ $67620

$67621-76072

$76073-84525

$84526-92977

$92978-101430 

 

8

≤ $75260

$75261-84667

$84668-94075

$94076-103482

$103483-112890 

 

Amount of Discount

100%

80%

60%

40%

20%

 

More than 8 family members, add $3820 for each additional family member.

 

 

 

 

 
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