Charity Care PolicyWilson Medical Center Summary Financial Assistance and Charity Care Policy
This policy is established to provide the framework within which the Hospital will provide indigent care and financial assistance.
Wilson Medical Center (WMC) is committed to providing charity care to persons for medically necessary services to those patients who have healthcare needs, are uninsured, underinsured, ineligible for any government healthcare benefit program, and who are unable to pay for their care based on their individual financial situation and within WMC’s established guidelines for eligibility and availability of resources. When eligible, either all, or a portion, of the patient’s debt is forgiven and written-off to charity care. Certain exclusions may apply, which include, but are not limited to elective services, balances covered by other funding sources including primary coverage such Liability insurance, and failure to cooperate in securing alternative funding sources.
Charity care may be available for patients who generally meet Medicaid family income and eligibility criteria and Federal Poverty Income guidelines. The granting of charity shall be based on an individualized determination of financial need, and shall not take into account age, gender, race, social or immigrant status, sexual orientation or religious affiliation. Other factors may be considered, which include, but are not limited to hardship cases and catastrophic medical expenses for an occurrence or over a period of time.Financial Assistance Guidlines:
WMC’s values of human dignity and stewardship shall be reflected in the application process, financial need determination and granting of charity. Requests for charity shall be processed after WMC receives the information used for processing the application. WMC will use its best efforts to notify the patient or applicant in writing after the determination is made.
Eligibility is generally determined by measuring the gross family income against the Federal Poverty Income Guidelines. In addition other relevant non-income resources, including but not limited to real estate, savings, life insurance, motor vehicles, etc., will be considered in reaching a determination of eligibility.
Eligibility guidelines will also take into consideration catastrophic events for patients whose income falls outside the guidelines. Patients whose gross income is less than three times the Federal Poverty Income Guidelines may be eligible for reduced monthly payments or uncompensated services in part or in full.
Documentation from various sources may be needed or required in order to determine eligibility for charity care or financial assistance. If such documentation is not available, the Hospital must be able to reasonably verify any information through sources such as employer, tax and property records, etc. to support a determination of eligibility. Alternative sources of financial assistance must be explored and determined to be unavailable before a patient is approved for financial assistance.
Charity is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with WMC’s procedures for obtaining charity or other forms of payment or financial assistance, and to contribute to the cost of their care based on their individual ability to pay. Individuals with the financial capacity to purchase health insurance shall be encouraged to do so, as a means of assuring access to health care services, for their overall personal health, and for the protection of their individual assets.
Patients eligible for financial assistance under the Wilson Medical Center Financial Assistance Program may be approved for uncompensated services in full or in part and/or reduced monthly payments.
Determinations for approval of assistance shall be made exclusively
by WMC and according to the following general guidelines:
2. The Hospital will review eligibility criteria for alternative financial assistance such as Medicaid, Cancer Program, Purchase of Care programs etc. and assist the patient in obtaining such assistance before determining final approval of assistance through the Wilson Medical Center Financial Assistance Program. Patients must satisfactorily cooperate with Medicaid eligibility or applicable third party payment sources in order to qualify for charity care under WMC’s policy. If the patient and/or guarantor fails to cooperate, they may be denied approval for uncompensated services or financial assistance.
3. Income and resources owned by any member of the patient’s family living in the household (budget unit) will generally be considered for determining eligibility for charity care or financial assistance.
4. Patients with annual income for the “budget unit” in excess of 300% (three-hundred percent) of the Federal Poverty Income Guidelines will generally not be considered as indigent. Income for seasonal employment (e.g. farm work, business ownership, etc,) may be determined using the previous 12 full months of income or income from the last tax return. Income from other means will be determined using the previous 12 months or the previous three months multiplied by four quarters, whichever is less.
5. Income refers to total cash receipts before taxes from all sources. Income includes, but is not limited to, regular payments from social security, railroad retirement, unemployment compensation, workers’ compensation, veteran’s benefits, public assistance, alimony, child support, pensions, regular insurance or annuity payments, and income from interest, rents, estates, or trusts. Non-tangible deductions from income such as depreciation, will generally not be considered for the purpose of arriving at business income.
6. Non-income resources available are considered in any determination of financial assistance. Resources may be personal assets or from a business. A determination will be made regarding the liquidity of assets and could result in reduced monthly payments.
7. Patients whose family income is 200% (two-hundred percent) or less, of the Federal Poverty Income Guidelines, may be considered indigent depending on the nature, extent, and availability of non-income resources such as real estate, savings, life insurance, motor vehicles, etc. The hospital may require verification of such information or be able to reasonably ascertain that such information is valid. Verification can be made through available resources such as tax and property records, W-2’s and paycheck remittances. If the patient qualifies, a portion of the debt or 100% of the debt will be written off as charity.
8. Because patients are normally expected to utilize or “spend down” non-essential assets to meet their medical expenses, patients will generally not be considered indigent when the value of non-essential assets exceeds a level deemed reasonable under all the circumstances. Hospital legal counsel may be consulted as necessary to confirm the extent, nature, and availability of resources, as well as to evaluate the suitability of securing payment from such resources through formal legal processes (e.g. promissory note, security agreement, deed of trust, confession of judgment, institution of civil action).
10. Patients whose income for the “budget unit” is greater than 200% (two-hundred percent) but less than 300% (three-hundred percent) of the Federal Poverty Income Guidelines may be considered as partially indigent. These patients may be eligible for reduced payments as outlined in the “Payment Schedule Guidelines” and/or part of the bill may be applied toward uncompensated or charity care as outlined in this policy. (Note: The “Payment Schedule Guidelines” will be periodically updated, as the Hospital deems appropriate.)
11. Assistance may be approved if Medicaid eligibility is met and it can be reasonably ascertained that the stated income is within the WMC Financial Assistance Program. All other guidelines must be met. Patients who have Medicaid QMB or MQB coverage (Qualified Medicare Beneficiaries) are deemed Indigent because Medicaid is paying the Medicare premium. These patients qualify as categorically or medically needy Medicaid and can be deemed indigent for Medicare purposes.
12. Patients who are not eligible for financial assistance within the general guidelines of this policy, but have unusual circumstances (e.g. income is in excess of Federal Poverty Income Guidelines and the patient has sizeable or catastrophic medical bills but does not possess the ability to pay) may be considered for an alternative payment schedule or financial assistance depending on the nature, extent, and availability of resources, income and non-income. Any determinations made will be documented and used as guidance for consistency in making future determinations.
13. Applications for Financial Assistance that have been returned by the patient are reviewed by the Collector to ensure all information is attached. Determinations of eligibility for financial assistance will be approved by the Director, Patient Financial Services, Patient Accounts Manager or Collections Supervisor, or Patient Accounts Collector under the Director’s supervision.
14. Information from a charity application may be used for up to 12 (twelve) months, except if changes have occurred. If the family income changes, family size changes or other non-income information changes, a new application must be made for approval. If an application has been denied, then a new application may be made for re-evaluation.
15. Accounts written-off to Bad Debt may be ineligible to make an application.
16. Payments made prior to approval of an application will not be refunded. Nothing prohibits a patient and/or guarantor from making a payment after the application has been approved. Payments made after approval will not be refunded.
17. Patient who have residual balances left after a primary, secondary, or tertiary insurance pays or balances left due to being underinsured may be apply for charity care.
Presumptive Financial Assistance Eligibility:
All funding sources must be exhausted or paid first (if a determination is made that a payment will not be realized from a possible funding source, it may be considered exhausted) for the categories below prior to approval of Indigent Care. There are instances when a patient may appear eligible for charity care discounts, but there is no financial assistance form on file due to a lack of supporting documentation. Often there is adequate information provided by the patient or through other sources, which could provide sufficient evidence to provide the patient with charity care assistance. In the event there is no evidence to support a patient’s eligibility for charity care, WMC could use outside agencies in determining estimate income amounts for the basis of determining charity care eligibility and potential discount amounts. Due to the inherent nature of the presumptive circumstances, an account may be approved for charity care. Presumptive eligibility may be determined on the basis of individual life circumstances that may include:
State-funded prescription programs;
Homeless Persons-A homeless person is an individual who has no home or place of residence and depends on charity or public assistance. Such individuals will be eligible for Indigent Care, even if they are unable to provide all of the documentation require for the Indigent Care application.
Deceased Patients-The charges incurred by a patient who expires may still be considered eligible for Indigent Care. For the Charity Care application, the deceased patient will count as a family member, but the income is zero. Accounts in an “Estate” status or situations where the estate has not been opened are not eligible for Indigent Care until the Estate is settled.
Inmates- Patients who are incarcerated may be considered eligible in the event the State or County has made a determination that the State or County are not responsible for charges and the inmate/patient is responsible for the bill. Charges incurred while in custody are usually paid through the Law Enforcement Agency and would not qualify for Indigent Care.
A Catastrophic event will be determined on a case-by-case basis. A number of factors will be considered using our existing guidelines. Catastrophic cases may include extraordinary medical expenses or hardship situations. All income and non-income resources are considered in the determination. All of the debt or a portion of the debt may qualify for charity care.The Patient Accounts Manager or Director will assist in making a Catastrophic event application determination.
Discounts For Uninsured Patients:
June 28, 2003
November 29, 2005
February 1, 2010
January 1, 2013