PURPOSE: To establish guidelines and procedures to determine patient eligibility for the purpose of granting community free care to patients unable to pay.
- Hospital will not exclude any person from receiving health care services because of their race, color, sex, creed, national origin, sexual orientation, handicap, or age. No patient, regardless of ability to pay, will be denied treatment for emergency services for conditions that are life threatening or could result in serious bodily harm.
- The annual amount of community free care will be determined by the financial status and budget of the hospital and approved by the Chairman and Board of Directors.
- The calculation of the amount generally billed to individuals who qualify for financial assistance will be based on the average of the three best negotiated commercial rates. Hospital will allow a five percent reduction of gross charges prior to calculating the percentage of eligible write-off to individuals who qualify under the Community Charity Care Policy.
Example: Gross patient charges: R100.00
Less 5% (average of3 best negotiated commercial rates) -5.00
Amount used for application of eligible Charity Care Discount R 95.00
- Community free care may be available for emergency and elective services applicable to inpatient, outpatient, skilled, home health, and hospice care.
- Charity care financing may be provided to those patients having no insurance coverage or inadequate third party insurance coverage at the time of admission or upon receipt of a retroactive denial.
- Accounts previously written off to bad debts but subsequently returned as uncollectible by the Hospital collection agency will be considered charity care because the professional agency has determined the patient is unable to pay the bill.
- If a person with an outstanding hospital bill declares bankruptcy or is deceased with no estate, the account will be classified as charity care.
- Patients applying for charity care must exhaust all government assistance programs first, such as Medical Assistance and General Relief.
- Patient Eligibility Criteria – The following criteria will be used to identify persons who are unable to pay for needed health care services.
- Confirmation that the patient is not covered or receives services that are not covered by a third party insurer or government program.
- The patient, financially, is not able to pay for the services or, under special circumstances, approved by the Chairman.
- Patient Financial Eligibility Criteria-The following financial criteria will be utilized for identifying persons unable to pay for needed services.
- The patients with gross monthly income of 10,000 or less
|Sr.#||Patient’s gross monthly income||% Discount|
|1||gross monthly income of R10,000 or less||100%|
|2||gross monthly income of R11,000- R20,000||75%|
|3||gross monthly income of R21,000- R30,000||50%|
|4||gross monthly income of over R31,000||0%|
- Individual net worth will also be a factor in determining eligibility.
- Circumstances may dictate that the above criteria be waived; however, all community free care must have approval of the Chairman or Treasurer as set forth in section D.7.
- It is the responsibility of the applicant to provide the hospital with the necessary information in order that we may determine eligibility.
- Applicant may be required to complete and sign a community free care application. The hospital may request to view the applicant’s recent Paystub, federal and state income tax return, or other proof of income or assets in order to make a financial determination.
- Community Free Care Administrative Procedure
- The financial status of the patient applying for community free care will be established as soon as possible after receiving the application and all requested information.
- The patient, physician, family member, hospital staff, or others can request community free care for a patient.
- Application for community free care for elective services should be made in advance of receiving the elective services. The patient should contact the hospital’s business office to provide the necessary information.
- The patient will be notified when their application for community free care has been accepted or denied.
- Insurance contracts will not be considered as community free care.
- There are no time limits or other restrictions on declaring an account or patient as free care. This includes time elapsed, collection status, type of care, or whether it is a deductible or the unpaid portion of a third party payment.
7. Accounts greater than R2500 will have the approval of the Business Office Manager, Treasurer and Chairman. Accounts ranging from R1000 -R2500 will be approved by the Business Officer Manager and the Treasurer. Accounts less than R1000 will be approved by the Business Office Manager, with the exception of items listed in A.6.