Financial Assistance Policy
Financial Assistance comes in many forms:
- Payment Plan – Thirty (30) days
- Payment plan – short term Twelve (12) months maximum
- Payment plan – long term
- Medicaid application assistance
- Hospital Bill Reduction (HBR) aka Charity Care – for emergent or medically necessary services, defined as services covered by the Oregon Health Plan, and cancer treatment services.
- Various pharmaceutical manufacturers drug replacement programs
- Uninsured discount
When extending charity care, there are specific state guidelines and federal mandates we use to ensure our Financial Assistance program meets IRS regulations.
For the purpose of this policy, Hospital Bill Reduction (HBR) is used interchangeably with the term Charity Care.
To achieve the balance between providing needed Financial Assistance for eligible patients with the broader fiscal responsibilities to keep the hospital financially viable.
- HBR is not provided for medically unnecessary or elective surgeries/procedures
- HBR is not provided for bariatric surgeries
- HBR is not provided for cosmetic surgery or procedures
- HBR is not provided for services needed as a result of illegal activities
- Applicants must supply all required documentation
- Applicants shall be required to follow the procedures in section 4 – 7 of this policy
- Hospital Bill Reduction is communicated to patients through various verbal and written communications: prior to rendering services*, during service or upon discharge through financial counseling, discharge planning; through patient statements; and during follow–up collection calls.
*Bay Area Hospital provides emergency care services pursuant to the Emergency Medical Treatment and Active Labor Act (EMTALA) regardless of a patient’s financial and/or insurance status.
- QUALIFICATIONS AND PROCESS
- The qualification for Hospital Bill Reduction is dependent upon, income, family size, and liabilities. The primary tools used to evaluate an applicant’s qualification level for financial assistance are as follows:
- Hospital Bill Reduction Application Form (8221–008): This form provides income, family size and liability information used for qualification review and determination.
- Insurance verification & eligibility validation
- Address verification and validation
- Bay Area Hospital provides HBR based on adjusted gross income, family size, and liabilities. A sliding scale of income is used to determine eligibility levels. The sliding scale is updated annually according to the Federal Poverty Levels published by the Department of Health and Human Services. See table A.
- Medicare patients that qualify for the state SMB/SMF programs that only pay their part b premiums will automatically qualify for HBR at 100% as their income has already been verified by the state as being below 135% of the federal poverty level
- HBR LEVELS – CHARGE ADJUSTMENT (“WRITE–OFF”)
- The table below illustrates the sliding scale used to determine the financial assistance level.
|Income as Percentage of FPL
||HBR Adjustment Percentage
|0 – 200%
|201 – 250%
|251 – 299%
|Up to 300 %
- HBR DOCUMENTATION AND REQUIREMENTS
- Required documents are as follows:
- Completion of the HBR Application form (8221-094).
- Copy of the last 2 years of Federal Income Tax Form 1040 and any backup schedules that may be relevant(Schedule C for self-employed individuals)
- Last 3 months of paystubs and/or proof of household income for the last 3 months.
- Documentation of the Oregon Health Authority’s or other state Medicaid’s denial of eligibility for Medicaid that shows the denial was for non-qualification for the program and not for failure to provide required information.
- Other documentation as requested to clarify income.
- Existing Medical Debt:
- All existing medical debt owed to other providers for which financial assistance is not available.
- LIMITATIONS, DISQUALIFICATIONS, AND OTHER REQUIREMENTS
- HBR is effective for twelve (12) months from the date of approval. The applicant(s) is responsible to inform Bay Area Hospital of any material change in income, family size, and/or liabilities which may affect eligibility for services received subsequent to HBR approval but still within the twelve (12) month approval period. Material changes could raise or lower the eligibility level, or disqualify the applicant for additional HBR.
- HBR will be denied if the medical expenses are the result of committing an illegal act including, but not limited to; driving under the influence of intoxicants, being the aggressor in a physical fight, or driving without motor vehicle insurance, illegal use of drugs, including someone else’s prescription drugs. (Per ORS 806.010).
- Charity assistance may be retroactively denied if the qualifying information is found to have been falsified.
- Effective April 1, 2014, patients who chose not to purchase insurance or fail to enroll in Medicaid (as required by the Affordable Care Act) may not be eligible for a HBR adjustment.
- When medical insurance is available through the patient’s health plan or another third party resource (e.g.: Personal Injury Protection or Premise Medical) but the patient does not want the insurance billed and/or refuses to file a claim, the charges will not be eligible for an HBR adjustment.
a. Prior to services whenever possible
- Applications for financial assistance:
- May be obtained from Patient Access or Patient Accounts
- May be printed from the hospital website at www.bayareahospital.org
- Are included with patient balance statements
- HBR applications are accepted:
b. Immediately following rendered services
c. Within 240 (two hundred forty) days from the first patient statement date
- REVIEW and APPROVAL PROCESS
- The completed HBR Application will be analyzed by Patient Financial Services to determine eligibility per BAH policy. If eligible, the value of the approval follows the hospital financial transaction policy (PURCH_MM19a).
- As part of the HBR review process, Bay Area Hospital may ask the applicant(s) for clarification of information provided.
- Applicants will receive written notification of the approval or denial of their HBR request within 21 (twenty-one) days of receipt of a completed application. An application is considered complete when the application is filled out entirely and required proof documents are provided. Denials will specify the reason for the denial; the guarantor may appeal the determination by providing relevant additional documentation to Bay Area Hospital within (30) days of the notice of denial. All appeals will be reviewed and if the determination on appeal affirms the denial, written notification will be sent to the guarantor. The final appeal process will conclude within thirty (30) days of the receipt of a denial by the applicant and no further appeals or documentation is received from the applicant. The written notification will be mailed through the USPS to the address on record, unless otherwise requested by the applicant.