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Charity Policy and Sliding Fee Program

This program is designed to provide free or discounted care to those who have no means or limited means, to pay for their medical services (Uninsured or Underinsured). It is the policy of Fishermen’s Community Hospital (FCH) to provide emergency care to all patients regardless of ability to pay. The hospital shall allocate resources to identify charity cases and provide uncompensated care based upon information submitted at the time of application for charity care by the patient or their representative.

Charity adjustments may only be granted to patients receiving non-elective care. Charity adjustments may be applied to approve accounts of uninsured patients based on the patient’s total gross family income and the patient’s cooperation in applying for Medicaid or other available coverage. In order to ensure the funds for uncompensated care are not abused and will be available for those in need within the hospital’s service area FCH will make reasonable attempts to assist eligible candidates to become covered under any available assistance programs in the community.

It is the policy of Fishermen’s Community Hospital to provide primary care to patients in our facility including the Physician Practice’s regardless of their ability to pay for those services. Uninsured and Underinsured Patients without the ability to pay will be offered consideration for payment reduction through the Sliding Fee Schedule Program. The Federal Poverty Guidelines, http://aspe.hhs.gov/poverty, are used in creating and annually updating the charity and sliding fee schedule (SFS) to determine eligibility.

Governance

The Charity and Sliding Fee Schedule policy is administered by the Patient Financial Services Director with authority and approval from the Fishermen’s Community Hospital Authority Board.

Definitions

  • Family Unit Size is defined as the applicant (patient if applicable), spouse and all legal dependents as allowed by the Federal Government. If patient/applicant is a minor, the family unit will include parent(s)/legal guardian(s) and all household dependents as allowed by the Federal Government.
  • Family Unit Income is defined as gross income for all family members of the family unit for the last three months or last calendar year, whichever is the lesser amount. Examples of income are salary/wages, tips, retirement, veteran’s administration, workers compensation, sick leave, disability compensation, welfare, social security retirement, alimony, child support, dividends, interest or income from property.
  • Uninsured patients are defined as patients without third party insurance coverage for health services.
  • Fishermen’s Community Hospital; includes all departments/locations within the organization that provide patient services, as well as, our Physician Practice’s Offices.

Scope/Procedure for Hospital/Physician Practice’s Based Services

Uninsured patients qualify for a charity adjustment on a sliding scale as follows:

  • Family Unit Income of 100% – 200% of the Federal Poverty Guidelines qualifies for a 100% charity discount, which means that their services are free.
  • Family Unit Income of 201%-300% of the Federal Poverty Guidelines qualifies for a charity discount of 75% of charges.
  • Family Unit Income of 301%-400% of the Federal Poverty Guidelines qualifies for a charity discount of 50% of charges.

The sliding scale income amounts will be updated as the Federal Poverty Guidelines are revised.

Insured patients can qualify for a charity discount if their family income falls in the above sliding scale. The discount will be calculated based on the insured patient responsibility using the above sliding scale.

Catastrophic Provision for Hospital/Physician Practice’s Based Services

Insured and uninsured patients who are not eligible for charity care and the patient’s responsibility exceeds 25% of the Family Unit Income may qualify for a catastrophic charity adjustment based on the following sliding scale:

  • Family Unit Income of 200% or less of the Federal Poverty Guidelines qualifies for a 100% charity discount, which means that their services are free.
  • Family Unit Income of 201%-300% of the Federal Poverty Guidelines qualifies for a charity discount of 50% of charges.
  • Family Unit Income of 301%-400% of the Federal Poverty Guidelines qualifies for a charity discount of 25% of charges.
  • Insured and uninsured patients whose family unit income exceeds $75,000 are not eligible for either category of Charity care.

Eligibility Criteria

Charity care is secondary to all other financial resources available to the patient. Insured patients are eligible for charity if their family unit income is 200% or less of the Federal Poverty Guidelines and they meet all other criteria. Patients who are insured and their family unit income is more than 200% of the Federal Poverty Guidelines are ineligible for the charity program but will be considered under the catastrophic provision should the remaining balance for which they are responsible exceed 25% of the gross family unit income.

Determination of eligibility of a patient for charity care shall be applied regardless of the source of referral and without discrimination as to race, color, creed, national origin, age, handicap status or marital status.

Patient care that is elective, cosmetic, experimental, or deemed to be non-reimbursable by traditional insurance carriers and governmental payors shall not be considered eligible for charity care under the Charity Care Policy. The hospital will make an effort to notify the patient in advance of the lack of eligibility of such care under the Charity Care Policy.

Charity care will be provided to uninsured and insured patients when net assets are not sufficient and gross family unit income is between 0 and 200% of the Federal Poverty Guidelines adjusted for family size.

Eligibility Determination

Eligibility can be determined once a completed application has been received along with ALL supporting documentation. Should the documentation not be supplied or should the application remain incomplete, charity will not be granted. In these circumstances the account(s) will be noted as uncooperative and will be subject to the normal account flow process of self-pay accounts.

Patient should be a resident of the hospital’s service area. Listed below are examples of acceptable proof of residency:

  • County Property Tax Assessment Statement
  • Utility bill showing current address
  • Rent receipt showing current address
  • Voter Registration Card
  • Valid Driver’s License

Cases for consideration may be requested by the patient, the patient’s family, the patient’s physician or recognized social agencies.

Following the initial request for charity, the hospital will pursue other sources of funding including Medicaid and/or state programs. If patient refuses to pursue any other source of funding, the patient will be ineligible for the Charity Care Program. All outstanding accounts will be notated as uncooperative and will be subject to the normal self-pay account flow process. Forms and instructions will be furnished to the responsible party when charity care is requested or when need is indicated.

The responsible party will be given fifteen (15) days or a reasonable time as required by the person medical condition to complete the required forms and furnish proof of income and assets.

If the application is approved for less than a 100% discount or denied, the patient and/or responsible party must immediately establish payment arrangements with Fishermen’s Community Hospital. Charity Care and Sliding Fee Schedule program approval applications will be applied to covered outstanding balances for three months prior to application date and any covered balances incurred within twelve months after the approval date, unless their financial situation changes significantly. The applicant has the option to reapply after the twelve months have expired or anytime there has been a significant change in family income. When the applicant reapplies, the look back period will be lesser of the three months or the expiration of their last Sliding Fee Discount Program application.

Application Process

All patients desiring consideration under the Fishermen’s Community Hospital Charity and Sliding Fee Schedule Program must apply for assistance by completing an application form and must disclose financial information that is considered pertinent to the determination of the patient’s eligibility for charity care. The applicant will authorize the hospital to make inquiries of employers, banks, credit bureaus and other institutions for the purpose of verifying statements made by the applicant.

When returned the application shall be accompanied by one or more of the following types of documentation as needed for the purpose of verifying income:

  • Payroll check stubs for last three months.
  • IRS tax return forms for the most recently completed calendar year.
  • Letter of support from another family member with the family member’s name address and amount of support signed and notarized.
  • Completed Verification of Income Form for patients who cannot provide any of the above documentation.
  • Proof of family income and family size are required.
  • Income will be annualized, when appropriate, based upon documentation provided and verbal information provided.

All applications, supporting documentation and communications will be treated with proper regard for patient confidentiality. Additional information may be requested to complete the application.

Notifications

Financial agreement forms will state that financial responsibility is waived or reduced if the patient is determined eligible for charity care. The hospital will make reasonable efforts to notify the patient of the final determination within fifteen (15) business days of receipt of the application and financial information. The notification will include a determination of the amount for which the responsible party will be financially liable. Denials will be written and include instruction for reconsideration.

Appeals process

The responsible party may request reconsideration of eligibility for charity care by providing additional verification of income or family size within thirty (30) calendar days of notification. The Director of Patient Financial Services or designee will review all requests for reconsideration and will make the final determination. If the determination affirms the previous denial of charity care, written notification will be sent to the patient/guarantor.

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