Springhill Medical Center, hospital and hospital-based clinics, wholly-owned by Springhill Medical Center.
For the purpose of this policy, the terms below are defined as follows:
Financial Assistance: Healthcare services that have or will be provided but are never expected to result in cash inflows. Financial Assistance results from a provider’s policy to provide healthcare services free or at a discount to individuals who meet the established criteria.
Family: Using the Census Bureau definition, a group of two or more people who reside together and who are related by birth, marriage, or adoption. According to Internal Revenue Service rules, if the patient claims someone as a dependent on their income tax return, they may be considered a dependent for purposes of the provision of financial assistance.
Family Income: Family Income is determined using the Census Bureau definition, which uses the following income when computing federal poverty guidelines:
Includes earnings, unemployment compensation, workers’ compensation, Social Security, Supplemental Security Income, public assistance, veterans’ payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources
Non-cash benefits such as food stamps and housing subsidies are not counted
Determined on a before-tax basis
Excludes capital gains or losses; and
If a person lives with a family, includes the income of all family members (Non-relatives, such as housemates, do not count)
Uninsured: The patient has no level of insurance or third party assistance to assist with meeting his/her payment obligations.
Under-insured: The patient has some level of insurance or third-party assistance but still has out-of-pocket expenses that exceed his/her financial abilities.
Hospital Based Clinics: Includes clinics in which the physicians are employed by a hospital and either provides services in the hospital or through a hospital based clinic. The hospital based clinic is included under the hospital’s license.
Uninsured Discount: A discount to an uninsured patient’s billed charged for medically necessary inpatient/outpatient hospital services and hospital-based clinic services in accordance with the guidelines of this policy.
In support of our values of integrity, trust, respect, compassion and stewardship, Springhill Medical Center Hospital and hospital based clinics are providing a discount on billed charges to patients for medically necessary care delivered to those who are uninsured and ineligible for government programs, or are otherwise medically indigent.
Springhill Medical Center Hospital and hospital based clinics strive to ensure that the financial capacity of people who need medically necessary services does not prevent them from seeking or receiving care. The discount program is not considered to be a substitute for personal responsibility, and patients are expected to cooperate with the procedures to obtain the discount and to contribute to the cost of their care based on their individual ability to pay. Individuals with the financial capacity to purchase health insurance shall be encouraged to do so, as a means of assuring access to health care services, for their overall personal health and protection of their individual assets.
A. All patients presenting for emergency care will be served regardless of residence or ability to pay.
B. The Hospital will pursue payment from the patient/guarantor for all deductibles, co-pays, coinsurance, and/or services not covered by insurance or other third-part payer.
C. The Hospital has a Financial Assistance Policy established to provide financial support to uninsured/underinsured patients who are unable to meet personal payment responsibilities and who meet established criteria. The determination that a patient or patient’s guarantor needs Charity Care or the Financial Assistance for these financial responsibilities may be made before or after services are rendered.
D. The Hospital will pursue all possible forms of third-party payment such as insurance, state Medicaid programs, and county indigent care programs before granting Charity Care or Financial Assistance. Patients/guarantors are expected to assist with all such efforts to obtain third-party payment.
E. The key elements of this policy will be communicated to the public through such vehicles as the Hospital’s web site and information packets distributed at registration.
A. Charity Care
1. Where possible, prior to the registration of the patient, a financial counselor will conduct a pre-registration interview with the patient, the guarantor, and/or his/her legal representative. If a pre-registration interview is not possible, this interview should be conducted upon registration/admission or as soon as possible thereafter. In the case of an emergency admission, the evaluation of payment alternatives should not take place until the medical care required to stabilize the patient has been provided.
2. The need for payment assistance shall be re-evaluated at each subsequent time of services if the last financial evaluation was completed more than 1 year prior, or at any time additional information relevant to the eligibility of the patient for financial assistance becomes known. Request for Financial Assistance shall be processed promptly and Springhill Medical Center shall notify the patient or applicant in writing within 30 days of receipt of a completed application. Patients requesting Charity Care assistance must complete the Confidential Financial Assistance income statements.
3. The Patient Accounting Coordinator will review, investigate, and evaluate the application. If the patient has a household income of less than 138% of the federal poverty level they will qualify for the Healthy Louisiana under the Louisiana Medicaid Expansion that was effective July 1, 2016. The patient will then be asked to schedule an appointment with one of our Medicaid Representatives for completion of the Medicaid application.
138% of the Federal Poverty Level for 2018
Household Size Weekly, Bi-weekly, Monthly, Yearly
5. If the determination has been made that the patient does not qualify for the Healthy Louisiana under the Louisiana Medicaid Expansion program but the patient falls between 138% - 200% of the Federal Poverty guidelines they will be eligible for the Financial Assistance Program. Once eligibility is determined the Collections Manager will review and sign off.
6. Key criteria for determining eligibility for Financial Assistance are:
a. Income between 138% and 200% of the federal poverty guidelines
b. Limited assets
c. Amount owed to Springhill Medical Center and to other healthcare providers
d. Cost of routine monthly necessities (required for health or safety), including prescriptions
e. Patient’s effort to pay any portion of dollars owed
f. Financial and personal consideration of others in the household
7. Payment expectations will be based on the federal poverty guidelines:
a. Payment of zero is expected for patients whose income is below 138% of the poverty guidelines.
b. Payment of 25% of the amount owed is expected for patients whose income is at 138% of the poverty guidelines.
c. Payment of 50% of the amount owed is expected for patients whose income is at 158% of the poverty guidelines.
d. Payment of 75% of the amount owed is expected for patients whose income is at 178% of the poverty guidelines.
e. Payment of 100% of the amount owed is expected for patients whose income is at 200% of the poverty guidelines or above.
8. The Chief Financial Officer will review the monthly Financial Assistance approvals and sign off.
9. Exceptions to the policy require the approval of the Chief Financial Officer and/or the Chief
V. Communication of the Discount Program to Patients and the Public
Information about available Financial Assistance shall be made available which may include the following: Notices posted at all points of patient check-in, information provided to the patient at time of registration, communication received from hospital business office or hospital based clinics. Such information shall be provided in the primary languages spoken by the populations served by the site. Referral of patient’s for financial assistance may be made by any member of Springhill Medical Center or its’ clinics including physicians, nurse practitioners, physician assistants, nurses, financial counselors, social workers, case managers, etc. A request for financial assistance may be made by the patient or a family member, close friend, or associate of the patient subject to applicable privacy laws.
VI. Billing & Collection Policies
Springhill Medical Center will attempt to obtain a financial assistance application and determine eligibility for all uninsured patients at or near the time of service.
Written notice will be mailed to the patient/guarantor for any incomplete application received.
Make and document a determination of whether the patient is eligible for charity care for a patient who submits a complete charity application.
Collection efforts will be made to determine a patient’s eligibility for charity care for a period of 120 days. During this period patients will receive 3 statements and 1 final phone call. After this period reasonable collection efforts will be considered to have been made and the patients account will be reviewed for collections placement and/or bad debt.
VII. Policy Changes: This policy may be revised at any time as business needs require.