Wilson Medical Center Summary Financial
Assistance and Charity Care Policy

PURPOSE: 
This policy is established to provide the framework within which the Hospital will provide indigent care and financial assistance. 

POLICY:
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 apply, which include, but are not limited to elective services, balances covered by other funding sources including Liability insurance, and failure to cooperate in securing alternative funding sources.

Charity care is available for patients who meet family income and criteria as determined by Medicaid eligibility criteria. 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.

FINANCIAL ASSISTANCE GUIDELINES:
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 promptly and WMC will use best efforts to notify the patient or applicant in writing within 30 days of receipt of a completed application. The hospital will attempt to determine indigent patients as early as possible in its process.

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.

Written documentation is 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.

1. The patient must complete an "Application for Financial Assistance Program" form, a "Financial Statement" form and provide written proof of income. These forms should be updated at least annually for all patients who qualify for financial assistance. (Sample forms are attached)

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 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. 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.

12. Applications for Financial Assistance that have been returned by the patient are reviewed by the Collector to ensure all information is attached. Applications and attachments are then forwarded to the Collections Supervisor for review. Determinations of eligibility for financial assistance will be approved by the Patient Accounts Manager or designated supervisor under the Manager's supervision.

13. 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.

14. Accounts written-off to Bad Debt are not eligible to make an application.

15. 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.

PRESUMPTIVE FINANCIAL ASSISTANCE ELIGIBILITY: All funding sources must be 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. Once determined, due to the inherent nature of the presumptive circumstances, the only discount that can be granted is a 100% write off of the account balance. Presumptive eligibility may be determined on the basis of individual life circumstances that may include:

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.

CATASTROPHIC DETERMINATIONS:
A patient and/guarantor may qualify for a Catastrophic Discount. Only medically necessary services are eligible for a Catastrophic Discount.

A Catastrophic event may be defined as any patient and/or guarantor with a self-pay balance greater than $15,000 (fifteen-thousand dollars) and income less than twice the 300% (three-hundred percent) sliding scale of the Federal Poverty Level. All income and non-income resources are considered in the determination. If the patient and/or guarantor qualify for the Catastrophic Discount, we require the patient and/or guarantor to pay 20% (twenty-percent) of their gross income toward the debt within a reasonable period of time, but not more than one year.

Balances will be considered once for a catastrophic event. As an example, if a patient has $15,000 in debt and meets other resource requirements, the balance is eligible for a catastrophic discount. At any point in time afterward, the patient incurs new debt, the prior $15,000 is not considered toward that event. The Patient Accounts Manager or Director must make the Catastrophic Discount application determination. Approval of the Catastrophic Discount is for a single event and balances for successive hospital visits are not considered approved automatically.

DISCOUNTS FOR UNINSURED PATIENTS:
Persons who have no health insurance coverage or who obtain medically necessary services not covered by their health insurance will be eligible for a 25% (twenty-five percent) discount off charges when payment in full is made under the Credit and Collection Point of Service Policy.