Financial Assistance Policy
It is the policy of Pella Regional Health Center, its family of clinics and home health and hospice services to provide medically necessary health care to all patients, without regard to the patient’s financial ability to pay.
Pella Regional Health Center and its health care providers are tax-exempt. With that, Pella Regional is called to meet the needs of patients and others who seek care, regardless of their financial abilities to pay for services provided. In order to remain tax-exempt, Pella Regional is required to adopt and widely publicize its financial assistance policy.
The purpose of this Policy is to outline the circumstances under which Pella Regional will provide free or discounted care to patients who are unable to pay for services and to address how Pella Regional calculates amounts charged to patients.
Eligibility for financial assistance will be considered for those individuals who are uninsured, underinsured, ineligible for any government health care program, and who are unable to pay for their care based upon a determination of financial need in accordance with policy.
All individuals who are eligible will not be charged more than the amounts generally billed for their emergency or medically necessary care.
After an assessment of medical necessity and financial ability, Pella Regional may provide free or discounted care to patients who qualify for financial assistance under this policy.
Inability to Pay Bills
Pella Regional follows fair billing practices required by the Health Care Finance Administration. This means Pella Regional staff must attempt to collect all amounts owed after insurance has paid from every patient served by our facility. Pella Regional follows standard procedures in determining eligibility for financial assistance and in collecting on delinquent patient accounts as follows:
Collection Policies and Procedures
As a courtesy, we file the patient’s initial insurance claim. If the claim is not paid within 45 days, the balance will become patient responsibility and, at this point, the patient will need to pay the balance in full or contact their insurance company.
Private Pay Status
At the time of admission, those individuals with no insurance are considered “Private Pay.”
Based on the balance, patients will be offered three options:
- Pay the balance in full within 30 days (cash, check, or credit card). An account is deemed payable in full upon receipt of the statement. If unable to pay in full within 30 days, the patient needs to contact the Business Office to discuss other options (contact information is printed on the statement for patient’s convenience). Failure to pay in full or failure to contact the Business Office may result in the account(s) being turned over to a third party collection agency. The statement and/or explanation of benefits from the insurance company is the notice that payment is due.
- Set up a payment plan. The monthly payment will be $50 or 10% of the balance due, whichever is greater. If the balance is $2,000 or greater, the monthly payment will be 5% of the balance.
- Patient may qualify for 20% private pay discount. To qualify for the discount the following criteria must be met:
- Patient does not have health insurance.
- Medically necessary services are not covered.
- Upon receipt of the first statement, contact the Business Office to indicate that they do not have insurance and would like to discuss the private pay discount. If the account/s qualifies, the patient pays the bill (minus the 20% private pay discount) within 60 days. After payment is received, the remaining 20% is adjusted off.
Pella Regional Health Center is a not-for-profit corporation, which fulfills its charitable purpose by providing health care services to Pella and surrounding areas. Pella Regional has established a financial assistance program to help patients with financial obligations. This program will consider a reduction of uncovered medical expenses for patients. This program is “needs based” and is not an entitlement program. It is the applicants’ responsibility to provide the appropriate documentation for consideration. We allow a 120 day notification period from date of first statement for financial assistance and 240 days for the application period. Forms are available from the Business Office, in the Registration areas and online at www.pellahealth.org.
Failure to Meet Financial Obligations
- Guarantor has received four or more statements.
- Guarantor receives “final notice” letting them know that the account must be paid in full or an agreed upon payment plan must be established. The final notice will notify the guarantor that the account will be sent to an outside collection agency after 30 days.
If the guarantor makes no attempt to pay, contact the Business Office, or return Financial Assistance application and has significant debt with Pella Regional, the possibility of terminating the physician/patient relationship will be considered pending notification to the physician.
Any patient seeking urgent or emergent care at Pella Regional shall be treated without discrimination and without regard to a patient’s ability to pay for care. The hospital operates in accordance with all federal and state requirements for the provision of emergent health care services, including screening, treatment and transfer requirements under the federal Emergency Medical Treatment and Active Labor Act (EMTALA).
Other Medically Necessary Services
Any patient seeking care at Pella Regional for the following reasons shall be treated without discrimination and without regard to a patient’s ability to pay for care:
- Services for a condition which, if not promptly treated, would lead to an adverse change in the health status of an individual;
- Non-elective services provided in response to life-threatening circumstances in a non-emergency room setting; and,
- Medically necessary services, evaluated on a case-by-case basis at Pella Regional Health Center’s discretion.
Pella Regional’s Financial Assistance Policy applies to Pella Regional Health Center services and employed physicians. Many physicians and the services they provide at Pella Regional Health Center are independent from the hospital. Fees charged by these physicians for services provided to you at Pella Regional will be billed separately and not come from Pella Regional Health Center. Any questions, including those regarding payment, payment plans or financial assistance must be directed to those entities. As staff is added and removed consistently, please contact the Business Office if you are concerned about a specific physician/service.
Charges for medical care provided to uninsured patients are not more than the amounts generally charged to those individuals who have insurance. These patients are allowed a 20% discount for payment within 60 days.
Charges for medical care provided to patients who cannot pay outright are also available. These patients are allowed to pay 10% of their balance due paid monthly (10 month re-payment plan) or a $50 minimum payment, whichever is greater. For balances over $2,000 patients are allowed to pay 5% of their balance due paid monthly.
Financial assistance for medically necessary services is available on a sliding scale of up to 100% of charges. A discount up to 100% will be extended to those uninsured or underinsured patients whose family income is equal to or less than 200% of federal poverty guidelines. Reduced monthly payment plans are available to those patients with incomes that exceed 200% of federal poverty guidelines but prove medical indigence or hardship.
Patients may also be extended a discount based upon medical hardship. A determination as to a patient’s medical hardship takes into consideration significant and/or catastrophic medical bills not covered by insurance, and other life-changing catastrophic events in addition to the patient’s income level and liquid assets. For example, a patient suffering a catastrophic illness may have a reasonable level of income, but a low level of liquid assets such that the payment of medical bills would be seriously detrimental to the patient’s basic financial (and ultimately physical) well-being. In this case, a patient may be extended discounted or free care, based upon the facts and circumstances.
Pella Regional staff understands and respects the stress and strain that is created by medical bills and can provide financial assistance to individuals who qualify. While support is based on need, and eligibility must be demonstrated we do have discretion as to whether to extend a discount related to patient accounts that do not clearly qualify under the basic financial ability criteria. Extension of financial assistance based on medical hardship will be based upon review of documents in addition to those evidencing income. Those documents may include, but are not limited to:
- Letter from physician confirming medical necessity of services provided
- Copies of unpaid patient/guarantor medical bills
- Information related to patient/guarantor drug costs
- Evidence of multiple instances of high-dollar patient/guarantor co-pays, deductibles, etc.
- Other evidence of high-dollar amounts related to health care costs
- Information concerning available insurance coverage
- Information concerning available liquid assets
Applying for Financial Assistance
Upon registration, and after all EMTALA requirements are met, patients without Medicare/Medicaid, or other adequate health insurance shall receive either a packet of information that addresses the financial assistance policy and procedures or immediate financial counseling assistance from staff, including the presentation of the application for financial assistance.
Patients requesting financial assistance will be required to complete the Financial Assistance Application Form in order to establish eligibility. Financial counselors are able to provide assistance with the application process if patient desires.
All available financial resources shall be evaluated before determining financial assistance eligibility. Facilities shall consider financial resources not only of the Pella Regional patient, but also of other persons having legal responsibility to provide for the patient (e.g., the parent of a minor child or a patient’s spouse). The patient/guarantor shall be required to provide information and verification of ineligibility for benefits available from insurance (i.e., individual and/or group coverage), Medicare, Medicaid, workers’ compensation, third-party liability (e.g., automobile accidents or personal injuries) and other programs. Patients with health spending accounts (HSAs) are considered to have insurance if the HSA is used only for deductibles and copays.
Calculating Amount Generally Billed
The IRS has identified two methods that may be used to determine the Amount Generally Billed. Of these, Pella Regional uses the Prospective Method. With that, the Amount Generally Billed is set at the amount the hospital facility determines would be the total payment for the care from Medicare or Medicaid reimbursement and Beneficiary payments, a 64% discount.
Approved Financial Assistance
Pella Regional patients/guarantors shall be notified when staff determines the amount of financial assistance discount eligibility. Patients/guarantors shall be advised that such eligibility does not include services provided by non-facility employees or other independent contractors (see Independent Services section). The patient/guarantor shall be informed that periodic verification of financial status shall be required in the event of future services.
Denied Financial Assistance
Pella Regional patients/guarantors shall be informed in writing if financial assistance is denied and a brief explanation shall be given for the determination. All denials must be credible and determined with the highest integrity.
Timing of Application
It is preferred that a request for financial assistance and a determination of financial need occur prior to rendering of non-emergent medically necessary services. However, the determination may be done at any point in the collection cycle. If financial assistance is approved, it will cover a period of six months.
Pella Regional Health Center’s values of compassion and stewardship shall be reflected in the application process, financial need determination, and granting of financial assistance. Requests for charity shall be processed promptly, and Pella Regional shall notify the patient or applicant in writing within 30 days of receipt of a completed application.
There are instances when a patient may appear eligible for financial assistance, 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 through other sources, which could provide sufficient evidence to provide the patient with financial assistance. In the event there is no evidence to support a patient’s eligibility for charity care, Pella Regional Health Center could use outside agencies in determining estimate income amounts for the basis of determining charity care eligibility and potential discount amounts. Presumptive eligibility may be determined on the basis of individual life circumstances that may include:
- State-funded prescription programs;
- Homeless or received care from a homeless clinic;
- Participation in Women, Infants, and Children programs (WIC);
- Food stamp eligibility;
- Subsidized school lunch program eligibility;
- Eligibility for other state or local assistance program that are unfunded (e.g., Medicaid spend-down);
- Low income/subsidized housing is provided as a valid address; and,
- Patient is deceased with no known estate.
For patients who qualify for financial assistance and who are cooperating in good faith to resolve their discounted hospital bills, Pella Regional Health Center may offer extended payment plans, will not send unpaid bills to outside collection agencies, and will cease all collection efforts.
Pella Regional Health Center will not impose extraordinary collections actions such as wage garnishments; liens on primary residences, or other legal actions for any patient without first making reasonable efforts to determine whether that patient is eligible for financial assistance. Reasonable efforts shall include:
- Validation that the patient owes the unpaid bills and that all sources of third-party payment have been identified and billed by the hospital.
- Documentation that Pella Regional Health Center has offered or has attempted to offer the patient the opportunity to apply for financial assistance pursuant to this policy and that the patient has not complied with the hospital’s application requirements.
- Documentation that the patient has been offered a payment plan but has not honored the terms of that plan.
Publicizing Availability of Financial Assistance
Pella Regional shall clearly post signage in English to advise patients of the availability of financial assistance. Signs shall be posted in other languages in instances where 5% or more of the local population speaks a foreign language. Every effort will be made to ensure that, for patients speaking languages other than those for which the financial assistance guidelines are printed, the policies are clearly communicated.
Pella Regional is required to maintain packets of information explaining staff provides care, without regard to ability to pay, to individuals with limited financial resources, and shall explain how patients can apply for financial assistance. In instances in which there are a significant number of patients not proficient in reading and writing, additional assistance shall be made available to complete necessary forms. In addition, Pella Regional locations with 5% or more non-English speaking populations shall prepare informational notices in each of the languages that account for 5% or more of the population.
Pella Regional will publish this policy to its web site, along with a link to the Financial Assistance Application Form. Pella Regional staff is responsible for ensuring that this policy and associated application are available on the Pella Regional’s web site at all times. The policy must be published in English, but may be published in other languages after appropriate review of the translated document has been performed.
Application of Procedures
Careful records shall be kept by Pella Regional of all financial assistance transactions.
The provision of financial assistance may now or in the future be subject to federal, state or local law. Such law governs to the extent it imposes more stringent requirements than this policy.