Financial Assistance Policy
FINANCIAL ASSISTANCE POLICY
It is the policy of Providence Hospital (the “Organization”) to ensure a socially just practice for providing emergency or other medically necessary care at the Organization’s facilities. This policy is specifically designed to address the financial assistance eligibility for patients who are in need of financial assistance and receive care from the Organization.
- All financial assistance will reflect our commitment to and reverence for individual human dignity and the common good, our special concern for and solidarity with persons living in poverty and other vulnerable persons, and our commitment to distributive justice and stewardship.
- This policy applies to all emergency and other medically necessary services provided by the Organization, including employed physician services and behavioral health, if applicable. This policy does not apply to payment arrangements for elective procedures or other care that is not emergency care or otherwise medically necessary.
- The List of Providers Covered by the Financial Assistance Policy provides a list of any providers delivering care within the Organization’s facilities that specifies which are covered by the financial assistance policy and which are not.
For the purposes of this Policy, the following definitions apply:
- “501(r)” means Section 501(r) of the Internal Revenue Code and the regulations promulgated thereunder.
- “Amount Generally Billed” or “AGB” means, with respect to emergency or other medically necessary care, the amount generally billed to individuals who have insurance covering such care.
- “Community” – for purposes of its Community Health Needs Assessment and this policy as Mobile County, Alabama. Mobile County, Alabama is the county of residence of approximately 83% of Providence’s patients.
- “Emergency Care” means care to treat a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbance, and symptoms of substance abuse) such that the absence of immediate medical attention could reasonably result in serious impairment to bodily function, serious dysfunction of any bodily organ or part, or placing the health of the individual, including a pregnant woman and her unborn child, in serious jeopardy.
- “Medically Necessary Care” means care that is determined to be medically necessary following a determination of clinical merit by a licensed provider. In the event that care requested by a Patient covered by this policy is determined not to be medically necessary by a reviewing physician, that determination also must be confirmed by the admitting or referring physician.
- “Organization” means Providence Hospital.
- “Patient” means those persons who receive emergency or medically necessary care at the Organization and the person who is financially responsible for the care of the patient.
Financial Assistance Provided
Financial assistance described in this section is limited to Patients that live in the Community:
- Patients with income less than or equal to 250 % of the Federal Poverty Level (“FPL”), will be eligible for 100% charity care write off on that portion of the charges for services for which the Patient is responsible following payment by an insurer, if any.
- At a minimum, Patients with incomes above 250 % of the FPL but not exceeding 295 % of the FPL, will receive a sliding scale discount on that portion of the charges for services provided for which the Patient is responsible following payment by an insurer, if any. A Patient eligible for the sliding scale discount will not be charged more than the calculated AGB charges. The sliding scale discount is as follows:
|Providence Hospital, Mobile AL|
|2018 HHS Poverty Guidelines Calculation Table*|
|Hospital Based Services|
|Household||Charity Care||Financial Assistance Program***||Uninsured with Means to Pay|
|Size||FPL*||0 to 200%||to 250%||to 295%||> 295%|
|Discount||1) Financial Assistance for the uninsured with Means to Pay discount is based on total charges.|
|Application||2) Insured discount is based on patient liability or balance due.|
|* Based on the Federal Register / document citation: Federal Register Vol. 83 / January 13, 2018 / pgs. 2642-2644|
|** For each additional person at 100% poverty, add $4320 (then, if necessary, multiply accordingly up to 295%)|
|*** Maximum owed by any patient per episode of care or account is 10% of gross household income|
- Patients with demonstrated financial needs with income greater than 295 % of the FPL may be eligible for consideration under a “Means Test” for some discount of their charges for services from the Organization based on a substantive assessment of their ability to pay. Income vs expenses will be reviewed and the patient cannot have a non-essential asset more than $1.00 greater than the hospital charges. A Patient eligible for the “Means Test” discount will not be charged more than the calculated AGB charges.
- For a Patient that participates in certain insurance plans that deem the Organization to be “out-of-network,” the Organization may reduce or deny the financial assistance that would otherwise be available to Patient based upon a review of Patient’s insurance information and other pertinent facts and circumstances.
- Patients that are eligible for 100% charity care may be allowed to pay a nominal flat fee of up to $250.00 for services.
- Eligibility for financial assistance may be determined at any point in the revenue cycle and may include the use of presumptive scoring to determine eligibility notwithstanding an applicant’s failure to complete a financial assistance application (“FAP Application”).
- Eligibility for financial assistance must be determined for any balance for which the patient with financial need is responsible.
- The process for Patients and families to appeal an Organization’s decisions regarding eligibility for financial assistance is as follows:
- If the patient feels critical information was left out of the original financial statement, they may appeal in writing listing the additional information and supporting documentation and why it was not provided originally. The appeal should be sent to the Business Office, Providence Hospital, P. O. Box 851537, Mobile, AL 36685.
- All appeals will be considered by Providence Hospital’s 100% Charity Care and Financial Assistance Appeals Committee, and decisions of the committee will be sent in writing to the Patient or family that filed the appeal.
Other Assistance for Patients Not Eligible for Financial Assistance
Patients who are not eligible for financial assistance, as described above, still may qualify for other types of assistance offered by the Organization. In the interest of completeness, these other types of assistance are listed here, although they are not need-based and are not intended to be subject to 501(r) but are included here for the convenience of the community served by Providence Hospital.
- Uninsured Patients who are not eligible for financial assistance will be provided a discount based on the discount provided to the highest-paying payor for that Organization. The highest paying payor must account for at least 3% of the Organization’s population as measured by volume or gross patient revenues. If a single payor does not account for this minimum level of volume, more than one payor contract should be averaged such that the payment terms that are used for averaging account for at least 3% of the volume of the Organization’s business for that given year.
- Uninsured and insured Patients who are not eligible for financial assistance may receive a prompt pay discount. The prompt pay discount may be offered in addition to the uninsured discount described in the immediately preceding paragraph.
Limitations on Charges for Patients Eligible for Financial Assistance
Patients eligible for Financial Assistance will not be charged individually more than AGB for emergency and other medically necessary care and not more than gross charges for all other medical care. The Organization will calculate one or more AGB percentages both using the “look-back” method and including Medicare fee-for-service and all private health insurers that pay claims to the Organization, all in accordance with 501(r). A free copy of the AGB calculation description and percentages may be obtained by request to the Business Office, Providence Hospital, P. O. Box 851537, Mobile, AL 36685.
Applying for Financial Assistance and Other Assistance
A Patient may qualify for financial assistance through presumptive scoring eligibility or by applying for financial assistance by submitting a completed FAP Application. A Patient may be denied financial assistance if the Patient provides false information on a FAP Application or in connection with the presumptive scoring eligibility process. The FAP Application and FAP Application Instructions are available online at www.providencehospital.org or at any Registration Office or the Business Office of Providence Hospital, 6801 Airport Blvd, Mobile, AL 36608.
Billing and Collections
The actions that the Organization may take in the event of nonpayment are described in a separate billing and collections policy. A free copy of the billing and collections policy may be obtained by written request to Providence Hospital, Attn: Business Office, P.O. Box 851537, Mobile, AL 36685.
This policy is intended to comply with 501(r), except where specifically indicated. This policy, together with all applicable procedures, shall be interpreted and applied in accordance with 501(r) except where specifically indicated.