Financial Assistance Policy

Financial Assistance Policy2019-02-25T15:04:37-05:00

Purpose

Perham Health is committed to provide emergency and medically necessary care to all patients without regard to race, creed, sex, national origin, disability, age, or ability to pay. This policy sets forth Perham Health’s policy and procedures to offer and provide financial assistance to all qualified patients receiving emergency and medically necessary care at all Perham Health facilities.

Policy

Patients receiving emergency or medically necessary care and services at Perham Health have the opportunity to apply for financial assistance. For patients who meet the eligibility criteria established in this policy, Perham Health will offer financial assistance that can reduce their financial obligations for payment of these services.

Definitions

For purposes of this policy, the following definitions apply:

Emergency Care and Services: Individuals who present to emergency departments seeking emergency care shall receive a medical screening examination by a qualified medical person to determine if an emergency medical condition exists. An emergency medical condition is one manifesting symptoms, including severe pain, psychiatric disturbances and/or symptoms of substance abuse, such that the absence of immediate medical attention is likely to cause serious
dysfunction or impairment to a bodily organ or function, or serious jeopardy to the health of the individual or unborn child. With respect to a pregnant woman having contractions, an emergency medical condition also includes situations where there is not enough time to safely transfer the woman prior to the delivery, or a transfer would pose a threat to the individual or her unborn child.

Medically Necessary Care and Services: Medically necessary care and services include procedures and treatments necessary to diagnose and provide curative or palliative treatment for physical or mental conditions in accordance with professionally recognized standards of health care. The term “medically necessary” does not include, for example, cosmetic procedures, birth control or fertility treatments, non-emergency dental services, experimental or non-traditional care, Myofacial, Acupuncture, Chiropractic, Massage Therapy, or retail services such as retail pharmacy, and retail durable or home medical equipment. For purposes of this policy, Perham Health reserves the right to determine, on a case-by-case basis, whether the care and services meet the definition and standard of “medically necessary” for the purpose of eligibility for financial assistance.

Eligibility Criteria for Financial Assistance: Upon Perham Health’s determination that the patient’s care and services meet either the definition of “emergency care and services” or “medically necessary care and services” a patient (whether uninsured or insured by a third party) is eligible to receive full or partial financial assistance subject to the following criteria:

  1. A patient (or a patient guarantor) with a household income of 200% or less of the Federal Poverty Level (FPL) is eligible for full financial assistance.
  2. A patient (or patient guarantor) with a household income between 200% and 300% of the FPL is eligible for partial financial assistance on a sliding scale.
    Household Size Chart *Add $4,320 for each person over 8
  3. Eligibility for full or partial financial assistance is contingent upon the completion of a Financial Assistance Application and submission of sufficient documentation requested by Perham Health to demonstrate financial need. Exceptional circumstances may influence a patient’s (or guarantor’s) eligibility for financial assistance and may be considered on a case-by-case basis.

Procedure

Availability of Financial Assistance

  1. Perham Health takes reasonable efforts to fully inform all patients and the public of the availability of financial assistance, including the following means of communication:
    • Posting of signs and brochures in all patient registration areas, waiting areas, exam rooms, Emergency Department, and in other public areas of the facility
    • Posting of information, including policies, billing statements, and the Financial Assistance Application on the Perham Health website
    • Mentioning the availability of financial assistance when discussing the bill over the telephone with patients or guarantors
    • Providing written notification in brochures and other information that is provided to the patient upon admission or discharge
  2. Perham Health takes reasonable efforts to help overcome any language or disability barrier that may serve as an impediment to informing patients and guarantors about the availability of financial assistance, including:
    • Multi-lingual signs in English and in any other language that constitutes the primary language of at least 5% of the population in the community where the facility is located
    • Multi-lingual information on the Perham Health website in English and any other language that constitutes the primary language of at least 5% of the population in the local communities where Perham Health facilities are located
    • Providing interpreters upon request of the patient or patient’s companion to accommodate either language or disability needs
  3. Perham Health’s Financial Assistance Policy, Financial Assistance Application, and a plain language summary are available free of charge, in English (or in other languages that constitute the primary language of the lesser of 1,000 people or 5% of the communities where Perham Health facilities are located). Individuals may obtain these documents through the following means:
    • Hard copies can be provided in person or can be mailed to the patient upon request
    • Perham Health website
  4. Once Perham Health has provided emergency or medically necessary services, a patient or guarantor may submit a Financial Assistance Application. The right to apply for financial assistance consideration begins on the date of service and extends through the 240th day after the first billing statement is sent to the patient or guarantor. However, patients and guarantors are encouraged to submit their Financial Assistance Applications as soon as possible.

Financial Assistance Application Process

  1. Patients (or patients’ guarantors) seeking financial assistance have the following obligations:
    • Complete, sign, and submit a Financial Assistance Application
    • Submit sufficient documentation to establish financial need, including the following documents: the latest filed IRS (1040) tax return, the two most recent pay stubs, and property tax statements for owned real property, most recent bank statement. Failure to include the aforementioned documents may result in denial of your application.
    • Respond to follow up questions and further requests for information so that Perham Health can accurately and promptly assess eligibility for financial assistance
    • Resolve and finalize any pending matters with applicable insurers and third party payers so that Perham Health can proceed with the processing of a Financial Assistance Application.
    • Cooperation in applying for other financial assistance available through state or local agencies if qualified under the eligibility criteria of such programs
  2. Patients (or guarantors) are expected to cooperate and to submit requested documents and information in a timely manner. Financial Assistance Applications will not be deemed complete until such time that the patient or guarantor submits all required documents. Perham Health allows patients and guarantors a reasonable amount of time to submit the supporting documentation and to respond to follow up requests. A pending or incomplete Financial Assistance Application will be cancelled if the patient or guarantor:
    • Fails to submit all required supporting documentation within 30 days, or
    • Fails to respond to any follow-up questions and requests within 30 days.
  3. In the event that the patient or guarantor applies for Financial Assistance after an unpaid account has been referred to an external collection agency, Perham Health will refrain from any extraordinary collection actions while the application remains incomplete and awaiting all required documents. However, in the event that a pending Financial Assistance Application is cancelled for a reason stated in the above paragraph, the unpaid account shall be subject to the terms and provisions of Perham Health’s Collections Policy.
  4. Upon receipt of a Financial Assistance Application that is deemed “complete”, Perham Health will:
    • Suspend all collection activity until such time that Perham Health makes a final determination on the eligibility for financial assistance
    • Make a determination of the eligibility for financial assistance within 30 days of receipt of a completed Financial Assistance Application
    • Notify the patient (or guarantor) by mail within 30 days of Perham Health’s determination to approve or deny the Financial Assistance Application
    • In cases where full or partial financial assistance is approved, make appropriate adjustments in the account to reflect the percentage and amount of financial assistance
  5. Subject to Perham Health’s discretion, once a patient or guarantor has qualified for Financial Assistance, the eligibility can be extended up to a maximum of four months from the approval date to cover future qualified care or services. To be eligible for this extended term, Perham Health may require patients or guarantors to provide updated financial information.
  6. Financial Assistance can be granted solely for medically necessary services and care performed by Perham Health’s providers or billed for Perham facilities through Patient Account Services.
  7. Services provided by non-Perham Health physicians, providers, facilities or organizations are not eligible for financial assistance granted through this policy.
  8. Perham Health shall maintain confidentiality for all Financial Assistance Applications and supporting documents and may share this information outside of Perham Health only upon written or verbal request from the patient or guarantor, or upon request by Perham Health’s external auditors, collection agencies, or law firms.

Granting Full or Partial Financial Assistance

  1. For patients or guarantors who are deemed qualified for full financial assistance, Perham Health will send a written notification by mail within 30 days of that determination.
  2. For patient (or guarantors) who are deemed qualified for partial financial assistance, Perham Health (or its external collection agency if the patient account has been referred to collections) will submit a bill to the patient or guarantor reflecting the discount for the partial financial assistance. In these cases, the amount accepted for payment for emergency or other medically necessary care will not exceed the amount Perham Health accepts as “payment in full” for the same services provided to patients who are insured by third party payers (including Medicare and all private health insurers).
    • “Payment in full” for insured patients has two components: the amount required to be paid by the third party insurer plus the amount required to be paid by the patient. Approved discounts will be calculated on the patient liability after insurance.
    • The “payment in full” amount is established by Perham Health by calculating the weighted average of discounts provided to Medicare and all private commercial health insurers. The “payment in full” calculation is established every twelve months by analyzing the actual claims paid to Perham Health by insured patients and their third party payers for the previous twelve months. Patient Accounting Services can provide this information free of charge at (218) 347-4500.

Collections Practices

Refer to the Collection Policies and Procedures. Patient Account Services can provide a copy of this policy, free of charge, upon request at (218) 347-4500.

Administration of this Policy

It is the responsibility of each Perham Health facility to develop local operating procedures to administer this policy, including the following:

  • Determination of local multi-lingual requirements for signage and other documents, and arrangements for interpreters
  • Education and training of staff for communicating Financial Assistance availability for patients served in their facility
  • Tracking procedures and account adjustment codes for Perham Health facilities that do not utilize Perham Health’s centralized billing function.