Financial Assistance Policy (Plain Language Summary)
CMH offers financial assistance, under its Financial Assistance Policy, to eligible patients unable to pay for medically necessary care. Eligibility for financial assistance is based on several factors including insurance coverage or other sources of payment, income, family size, assets and any special considerations the patient would like to have considered. Patients seeking financial assistance must comply with the Financial Assistance application process, including submitting tax returns, bank statements, pay stubs, as well as completing the application process for all available sources of assistance, including Medicaid.
The patient or any person involved in the care of the patient can express financial concerns at any point during the patient's care. The patient will then complete the financial assistance application, which can be submitted at any time prior to the account receiving a court judgement. Any information submitted will be treated as protected health information under the Health Insurance Portability and Accountability Act (HIPPA).
It is the policy of Community Memorial Healthcare, Inc. to ensure the billing and collection processes for uninsured/underinsured patients reflect our commitment to serve the community and meet the financial needs of the persons in that community.
This policy covers all non-elective inpatient or outpatient acute treatments and procedures in all of our facilities. It will be reviewed annually.
Discounts offered under this policy will not in any way be tied to future access to or provision of healthcare services covered by a federal or commercial program or payer. Similarly, no discount will be offered in response to current, past or future health services as a kickback for accessing these services. The existence of this policy will not be used in any marketing effort aimed at patients or healthcare providers.
Uninsured Patient - An individual who is uninsured, having no third-party coverage by a commercial third-party insurer, an ERISA plan: a Federal Health Care Program (including without limitation Medicare, Medicaid, S CHIP and CAMPUS), Workers' Compensation, Medical Savings Accounts or other coverage for all or any part of his bill, including claims against third parties covered by insurance, but only if payment is actually made by such insurance company.
Uninsured Patient Financial Assistance- A reduction in an Uninsured Patient's billed charges for inpatient or outpatient hospital or clinic services in accordance with the Uninsured Patient Financial Assistance Guidelines.
Federal Health Care Program - Any health care program operated or financed at least in part by the federal, state or local government.
Uninsured Patient Financial Assistance Guidelines - The matrix for determining an Uninsured Patient's liability for payment of billed charges.
Underinsured Patients - Patients who are insured or qualify for governmental or private programs that provide coverage for services rendered but do not have resources to pay the private portion of their bill.
Household - includes all individuals residing together, related or not.
Income - includes all monies brought into the household and the value of any gifts and/or support provided by others such as free/discounted rent, utilities, car payments, food, etc. In addition excess liquid assets will be added as income.
Excess Liquid Assets - will be considered liquid if they can be converted to cash within one year. These include checking accounts, savings accounts, trust funds and other investments. Additionally countable assets include the liquidated value of luxury items, equity in recreational vehicles, boats, second homes, etc. Excess liquid assets will be the amount in excess of two months normal living expenses.
BILLING FOR THE UNINSURED
All uninsured patients will receive a discount from standard charges on their bill. This discount will be set at 5% of billed charges. Any further adjustments will be based on the Charity/Financial Assistance guidelines below. We will help uninsured patients with inpatient, or large outpatient bill, determine eligibility for programs that may be available to cover medical costs.
Uninsured Patient Financial Assistance is applicable only to items and services allowable under the Medicare Program.
This policy applies only to inpatient, outpatient or emergency room services and services performed by physicians/midlevels employed by CMH.
Upon request, Uninsured Patients eligible for discounts described in this policy must complete an application for Medicaid participation or for coverage by other Governmental payment programs.
BILLING FOR THE UNDERINSURED
Patients with insurance, or that are covered by government or private programs may have the private pay portion of their bill adjusted based on the Charity/Financial Assistance guidelines below.
1) Notice of Patient Financial Assistance Policy:
a) CMH will post at inpatient, outpatient and clinic admission areas notice of its Patient Financial Assistance Policy.
b) During the collection process, CMH will again notify patients of our Patient Financial Assistance Policy.
2) Eligibility Determination
a) CMH personnel will give patients the Patient Financial Assistance Policy upon request by the patient. The Uninsured/Underinsured Patient must complete the Application for Financial Assistance and provide the information described in Paragraph 2(b) below. Following the patient's completion of the application, CMH personnel will review the application against eligibility criteria. The patient will provide supporting documentation of his level of income.
b) In evaluating a patient's need for financial assistance, personnel may review the patient's W-2 withholding forms, written verification of wage from employer and written verification from a public welfare agency or other governmental agency attesting to the patient's income status. Upon request, a patient may supply documentation reasonably necessary to verify the patient's income.
c) CMH will use the Federal Poverty Level Information available for the applicable calendar year to determine a patient's eligibility to receive financial assistance.
3) Patient Cooperation
a) If the patient meets the eligibility criteria, CMH will provide the patient with a certification statement.
b) The eligible patient must sign a certification statement verifying his household income level. CMH may contact the patient's employer, if any, to verify patient's status or may request additional documentation of income
Calculation of Financial Liability:
CMH personnel will calculate the financial liability of an Uninsured/Underinsured Patient based upon the patient's household income based on the following:
The amount that the patient or responsible person is obligated to pay is tied directly to income to the household and the household size using the Federal Poverty Level published each year.
CMH will provide medically necessary inpatient and outpatient hospital and clinic services (including emergency room services) to Uninsured/Underinsured Patients with household income levels at or below 150% of the Federal Poverty Level (FPL) with no out of pocket patient responsibility.
For households with income above 150% of FPL, out of pocket responsibility will be capped annually at 50% of household income that exceeds 150% of the FPL. [(Household Income - 150% of FPL)/2]. For uninsured patients, CMH will use the lower of the responsibility calculation or Amounts Generally Billed (AGB). CMH calculates AGB monthly using the average adjustments from all insurance payers (including Commercial, Medicare, Medicaid, etc.) over the past 12 months with separate calculations for Inpatient, Outpatient, and Clinic services.
Nothing in this policy shall prohibit CMH from offering reduced (as provided in the paragraph below) or more favorable financial assistance to a patient based on circumstances, including, without limitation, the patient's or household's net worth, likelihood of future earnings being sufficient to meet health care-related obligations within a reasonable time, the patient's other reasonable financial obligations, evaluation of the patient's health services history and the patient's need for future services, whether an account is discharged in bankruptcy, whether an account is for a deceased person having no estate or other means of payment and whether there exist other sources of payment.
REVIEW AND APPROVAL
Uninsured/Underinsured Patient Financial Assistance offered under this Policy is subject to review by CMH management to ensure compliance with this policy.
If and when a collection agency contracted by CMH, through their extensive asset validation, deems an account uncollectible due to lack of assets the account will be recognized as charity.
CMH reserves the right to grant financial assistance discounts in extraordinary circumstances to Uninsured/Underinsured Patients who do not meet the guidelines stated above. It is recognized by the parties that there are a very small percentage of the uninsured/underinsured patient population which has very substantial assets and could easily afford to pay for health care, but who, because of having tax exempt income or otherwise, will not have income reflected on a tax return or otherwise. To address these limited and extraordinary situations, CMH reserves the right to exempt these individuals from charitable/financial assistance.
Collection/legal action may be used to collect amounts due if the responsible party refuses to cooperate in the charity determination process and make and follow suitable payment arrangements. In addition, collection/legal action may be used to collect amounts that remain after financial assistance determinations have been made and the responsible person fails to make and follow suitable payment arrangements. Legal action may be taken to attach wages when it is believed that there is sufficient income to pay the amount due after collection efforts have failed.
For more information, please contact Shelly Day at (785) 562-4450.
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708 North 18th Marysville, KS 66508 (785) 562-2311