Charity Care Policy

Elk Regional Health Center recognizes its obligation to serve all individuals in need of medical care regardless of financial ability. Therefore, a charity care program is in effect for indigents seeking healthcare, as well as for community service programs; additionally, to define the charity care package available to patients requesting financial assistance for medical services, and a consistent process for eligibility determination.
 
 

Policy
Elk Regional Health Center, recognizing its obligation to contribute to a health community regardless of a patient’s ability to afford medical services, renders free or reduced-fee care to eligible patients. Eligibility for free/reduced care is based on the poverty guidelines issued annually by the department of health and human services. Liquid assets and medical expenses are utilized in the determination of eligibility. The need for charity care is addressed as soon as the individual indicates a financial hardship. Generally, this occurs at the time of service or upon the initial billing. 
 
 

Definitions

  • Charity care: The inability of a patient or responsible party to pay for some or all medical services rendered.
  • Medical Indigency: Health insurance coverage does not provide full coverage for all of the medical expenses and the self-pay medical expenses, in relationship to the family income, would make the patient indigent if the patient were required to pay full charges for the medical expenses.
  • Family: Directly related individuals residing within a household, including college students (regardless of their residence) who are supported by their parents or others related by birth, marriage or adoption.
  • Liquid Assets: Cash, checking, savings and money market accounts, matured certificates of deposit, mutual funds and bonds that may be cashed without penalty, and other easily convertible investments.
  • Large Medical Bill: The medical bill is for one visit, one stay or a series of on-going treatments that are the same service, such as radiation therapy, cardiac rehab, etc.
  • Under-insured: Benefit exclusion exists in the patient’s medical policy. Benefit exclusions include pre-existing conditions, or an exclusion of a benefit such as mental health benefit.

 
 

Procedure
Elk Regional Health Center will provide financial assistance to an individual who clearly demonstrates an inability to pay. A patient may apply for charity care for any amount he or she deems unable to pay.

The Health Center’s primary criteria for determining inability to pay is to compare the patient’s level of income to the established poverty level based on guidelines utilized under the Hill Burton Act (see below). Secondary criteria will include indicators such as the patient’s net worth, personal catastrophe or extraordinary medical bills. Those eligible to apply for charity care (beyond the above mentioned criteria) are those who are uninsured, under insured and ineligible for full benefits under the medical assistance program. Applicants may include individuals, spouses, and children (under the age of 19) and full time students who are still being supported by their parent or guardian.

Prior to being approved for charity care, an eligible patient must have exhausted all other possibilities for third party payer reimbursement including applying for medical assistance. Requested documentation by the board of assistance office should be submitted to justify the determination of the state and deemed necessary as part of the charity care application.

An individual requesting financial assistance under the financial aid program must apply for medical assistance and then will be required to complete an application for financial aid (see attached form). This source document is utilized to calculate the financial award. This process should be done as soon as possible, preferably before or at the time of service. All awards are reviewed by the patient access director for completeness and all awards must be approved /denied by the patient access director or patient accounts manager.

A patient will have ninety (90) days to make application. After that time, the request will be denied. Accounts previously in collection will not be approved under this charity care program. Any account recently placed in collection should be considered. Charity care applications should be kept on file for a period of six months considering all medical bills for that period of time. Patients previously accepted under the charity care program must file a new charity care application once the six month time period has lapsed to be eligible for consideration of future charity care awards.

Below are the revised poverty income guidelines currently under the Hill-Burton program:

 

Category A

Category B

Category C

Family

Equal to

Greater

Less

Greater

Less

1

11,670.00

11,670.00

23,340.00

23,340.00

46,680.00

2

15,730.00

15,730.00

31,460.00

31,460.00

62,920.00

3

19,790.00

19,790.00

39,580.00

39,580.00

79,160.00

4

23,850.00

23,850.00

47,700.00

47,700.00

95,400.00

5

27,910.00

27,910.00

55,820.00

55,820.00

111,640.00

6

31,970.00

31,970.00

63,940.00

63,940.00

127,880.00

7

36,030.00

36,030.00

72,060.00

72,060.00

144,120.00

8

40,090.00

40,090.00

80,180.00

80,180.00

160,360.00

 
Add $4,060.00 (Category A); $8,120.00 (Category B); or $16,240.00 (Category C) for each family member in excess of eight. If your family income is less than or equal to the mount of Category A, you are eligible for no-cost healthcare services. These figures are defined by Department of Health and Human Services guidelines, effective January 2014.

The patient's share of charges is as follows

Category A: 0 percent
Category B: 40 percent
Category C: 60 percent

 
 

Accounting for Charity Care Write-Offs
The credit office will make every effort to identify and differentiate write-offs deemed to charity under this policy. Separate general ledger allowance accounts will be maintained.

The patient access director is directly responsible to ensure that patients with outstanding accounts are informed concerning this charity care policy and for the proper documentation of patient eligibility.  Documentation of successful and unsuccessful requests for charity care will be maintained in the patient’s file. Patient unresponsiveness to the patient access director’s efforts will also be documented.  A charity care log will be maintained to document all such efforts.

This policy may be amended or suspended by action of the Board of Directors at any time.

For accounting purposes only: A financial aid case differs from a bad debt in that the hospital does not expect payment from the patient in the case of the patient having been designated as a charity case, while the hospital was expecting payment for a bad debt. Therefore, both gross revenue and accounts receivable will be reported net of financial aid.  Disclosure will be made in the annual audited financial statement by footnote only.

Revised: Feb 2014
 
 

Eligibility Form