Financial Assistance Policy


To provide emergency and medically necessary health care services to all patients regardless of their insurance status or ability to pay. In no event shall any person be denied medically necessary inpatient and outpatient hospital services, including emergency room services and hospital services provided at the Medical Center's satellite clinics; excluding retail pharmacy. However, as a condition of receiving medically necessary care, patients may be required to complete an Application for Financial Assistance and otherwise comply with the steps described in this Policy after treatment.




Uninsured Patient means 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, SCHIP and CHAMPUS), workers' compensation, medical savings accounts or other coverage for all or any part of his or her bill, including claims against third parties covered by insurance to which the Medical Center is subrogated, but only if payment is actually made by such insurance company.

a. The Medical Center will provide a discount on charges for Uninsured/Underinsured Patients for medically necessary inpatient and outpatient hospital services, including emergency room services and hospital services provided at the Medical Center's satellite clinics, in accordance with Attachment A to this Policy.

b. Discounts for Uninsured/Underinsured Patients pursuant to this Policy apply only to "covered items and services" for medically necessary treatment, which shall include those items and services covered by Medicare from time to time.

c. Upon request Uninsured/Underinsured Patients eligible for discounts described in this Policy must complete an application for Medicaid participation or for coverage by other governmental payment programs.


a. Discounts will be provided for the timely payment of self-pay and after- insurance balances in accordance with Attachment B to this Policy. Nothing in this Policy prevents Uninsured Patients from receiving discounts based upon both Attachment A and Attachment B.


a. Notice of Charity Patient Payment Assistance Program, also known as FAP, Financial Assistance Program. This program is based on the current year Federal Poverty Guideline with a range of 200% to 300% of the poverty guideline, and also based on income and family size (see attachment A).

b. An FAP eligible individual will not be charged more than the amounts generally billed (AGB) for emergency or other medically necessary care. Our AGB is computed using the prior fiscal year 12 month period. The calculation consists of our Medicare, Commercial insurance and Managed Care insurances total payments received divided by their total charges billed producing a percentage amount. The result for current year usage is 28%.


a. PFS Billing shall send two (2) claims and two (2) CCI letters.

b. The Medical Center shall work with patients to establish a reasonable payment plan.

c. The Customer Service Team Leader shall send the CCI letter series at day 42.

d. Cases may be referred to a collection agency after 120 days. Referrals for debt collection purposes must be approved by the Chief Financial Officer and shall be made only to agencies that have entered into a written agreement with the Medical Center setting forth the scope of permissible collections activities.

e. Prior to pursuing collection activities, the Medical Center shall ensure that the patient has no pending applications for financial assistance with Medicare, Medicaid, or other governmental or private assistance programs.

f. In pursuing debt collection activities, the Medical Center shall treat Medicare and non-Medicare patients in the same manner.

g. If the debt collection agency is unsuccessful, accounts exceeding two thousand dollars ($2,000) and all accounts where the patient has received payment from an insurance company or other source but refused to pay the Medical Center will be referred for legal action.

h. If a patient has refused to provide documentation required by this Policy, legal action will initially be taken to obtain the documentation needed to determine the patient's ability to pay. This documentation will be used to determine whether further action to obtain payment is warranted.

i. Attachment of assets may be considered on a case by case basis, but under no circumstance may a primary residence be attached.

5. Attachments

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