(i) No one will be denied access to services due to inability to pay, and
(ii) There is a discounted/sliding fee schedule available based on family size and income.
Purpose:
The purpose of this policy is to define and establish Fairview Regional Medical Center’s guidelines on charity care or financial assistance.
Policy:
See Attached Policy
Procedure:
See Attached Procedure
potential discount amounts. Presumptive eligibility may be determined based on individual life
FAIRVIEW REGIONAL MEDICAL CENTER
CHARITY POLICY
It is the policy of Fairview Regional Medical Center to grant our patients access to essential or non-elective care, regardless of their ability to pay or their ethnic origin.
Each patient or guarantor on behalf of the patient must complete a Financial Assistance Application to be considered for free or discounted care due to financial need.
For patients who are ineligible for financial assistance, it is the policy of this Health System to permit patients who meet policy guidelines to make scheduled monthly payments. Failing fiscal responsibility under charitable guidelines, Fairview Regional Medical Center has a Collection Policy in place and when appropriate, may utilize external collection firms or legal assistance for the purpose of collecting from those who are able but fail or refuse to resolve their indebtedness to FRMC. In the event of patient default on an account that has received a charity adjustment only the amount remaining after charity adjustment will be sent to a professional collection agent.
It is the policy of Fairview Regional Medical Center to:
- Treat all patients equally – with dignity, respect and compassion
- Serve the emergency health needs of everyone regardless of their ability to pay
- Assist patients who cannot pay for part or all the care they receive at Fairview Regional Medical Center
- Balance the needed financial assistance for some patients with broader fiscal responsibilities in order to keep FRMC viable financially
- Respond promptly to patients’ questions regarding their bills and requests for financial assistance
- Make information available to patients regarding our charity care policy
- Have clear understanding of written policies in order to assist patients in determining eligibility for public or hospital sponsored financial assistance programs
- Have written policies of discounts available to patients who do not qualify under FRMC’s charity policy
Procedure:
The intent of Fairview Regional Medical Center is to establish a fair and equitable system for determining charity care. General guidelines are established, allowing for evaluation of unique financial circumstances.
The criteria for granting charity care are gross income and the size of the family unit in accordance with Department of Health and Human Services (DHS) poverty guidelines. DHS publishes updates to its poverty guidelines annually.
Present income and family size will be measured in assessing charity care eligibility. Among other elements to be considered are temporary factors such as short-term layoff, unemployment, disability or other demonstrated hardship. Medical indigence can be a qualifying factor in determining charity care or uncompensated care.
Applications for assistance are available at Fairview Regional Medical Center between 8:00AM and 5:00PM, Monday through Friday ed in the FRMC Business Office. Services eligible for charity care are medically necessary clinic visits, in house lab, and x-ray services.
Information regarding the Charity Policy will be posted in common areas of the hospital and clinic and on the FRMC website.
Program Guidelines:
- Charity care eligibility is evaluated based on family size and income.
- A determination of the applicant’s eligibility is made promptly after completion of the application. Charity care discounts will cover outstanding balances for 90 days prior to application date.
- Income Guidelines: Patients in households with incomes below 200% of the Federal Poverty Level (FPL) receive discounts on a sliding fee scale. Patients with incomes less than 100% FPL pay a nominal fee.
Nominal fees: Clinic visit-$50.00
Lab (in-house)- $25.00
X-ray- $50.00
4. Underinsured patients will be defined by FRMC as patients whose out of pocket healthcare expenses are equal to exceed 10% of their annual income.
5. Amounts may be deemed as charity by external collection agencies and/or attorneys upon cancellation of a debt back to Fairview Regional Medical Center.
6. FRMC staff may request copies of documentation deemed necessary to verify the information provided by the applicant, such as most recent tax returns, last year’sW-2s, Social Security benefit letter, or 3 most recent pay stubs for all income in the household.
7. A re-evaluation of patient eligibility will be performed annually.
The following sliding scale displays the adjustments offered by Fairview Regional Medical Center:
| Poverty Level | <100% | 120% | 140% | 160% | 180% | 200% | >200% |
| Family Size | Nominal Fee | Discount 80% | Discount 60% | Discount 40% | Discount 20% | Discount 10% | Discount 0% |
| 1 | $15,060.00 | $18,072.00 | $21,084.00 | $24,096.00 | $27,108.00 | $30,120.00 | >$30,120.00 |
| 2 | $20,440.00 | $24,528.00 | $28,616.00 | $32,704.00 | $36,792.00 | $40,880.00 | >$40,880.00 |
| 3 | $25,820.00 | $30,984.00 | $36,148.00 | $41,312.00 | $46,476.00 | $51,640.00 | >$51,640.00 |
| 4 | $31,200.00 | $37,440.00 | $43,680.00 | $49,920.00 | $56,160.00 | $62,400.00 | >$62,400.00 |
| 5 | $36,580.00 | $43,896.00 | $51,212.00 | $58,528.00 | $65,844.00 | $73,160.00 | >$73,160.00 |
| 6 | $41,960.00 | $50,352.00 | $58,744.00 | $67,136.00 | $75,528.00 | $83,920.00 | >$83,920.00 |
| 7 | $47,340.00 | $56,808.00 | $66,276.00 | $75,744.00 | $85,212.00 | $94,680.00 | >$94,680.00 |
| 8 | $52,720.00 | $63,264.00 | $73,808.00 | $84,352.00 | $94,896.00 | $105,440.00 | >$105,440.00 |
| For each additional person, add | $5,140.00 | $6,456.00 | $7,532.00 | $8,608.00 | $9,684.00 | $10,760.00 | >$10,760.00 |
Presumptive Charity/Financial Assistance Eligibility:
Fairview Regional Medical Center understands there are instances when a patient/guarantor may appear eligible for charity/financial assistance, but there is no application on file or the patient/guarantor may be unable to complete an application. In the event there is no evidence to support a patient’s/guarantor’s eligibility for charity/financial care, FRMC could use outside agencies in determining estimate income amounts for the basis of determining eligibility and circumstances that may include:
1. Participation in state funded prescription programs
2. Participation in Women, Infants and Children programs (WIC)
3. Food stamp eligibility
4. Subsidized school lunch program eligibility
5. Eligibility for other state or local assistance programs that are unfunded
6. Low income/subsidized housing is provided as a valid address
7. Patient is deceased with no known estate
8. Patient states that he/she is homeless, the due diligence efforts are to be documented
9. Patient is mentally or physically incapacitated and has no one to act on his/her behalf
10. Patient is currently eligible for Medicaid, but was not eligible on a prior date of service
When a patient/guarantor does not complete an application and there is adequate information to support the patient’s inability to pay, waiving of charges may be granted. Waiving of charges must be approved by FRMC administration and should be documented along with an explanation.
Discounts: Uninsured, Self-Pay Patients not approved for Charity care:
Patients needing non-emergent services will be required to pay all estimated total charges prior to services being performed and will receive a forty percent (40%) self-pay discount. If full payment cannot be made and the patient is in good standing with FRMC, a financial arrangement will be made; however, a minimum payment of ten percent (10%) of that day’s estimated total charges will be required prior to services being performed.
Patients needing clinic services will be required to pay for the visit prior to being seen by the provider and will receive a twenty percent (20%) self-pay discount. If payment cannot be made, the patient will be screened by a nurse. If the nurse determines that the patient does not have immediate needs, the patient will be rescheduled for a time when payment can be made.
Monthly Payment Arrangements: See Collections Policy
Use of Outside Agencies/Attorneys: See Collections Policy
Litigation: See Collections Policy
PRESUMPTIVE FINANCIAL ASSISTANCE
____________________________
Name or Accounts
DO ANY OF THE FOLLOWING APPLY TO THE HOUSEHOLD?
| HOMELESS | |
| WIC | |
| SNAP BENEFITS | |
| OKLAHOMA HEALTH CARE (SOONERCARE, INSURE OKLAHOMA, OEPIC | |
| SUSIDIZED SCHOOL LUNCH PROGRAM | |
| SUBSIDIZED HOUSING | |
| DISABILITY INCOME | |
| SOCIAL SECURITY INCOME ONLY | |
| UNINSURED | |
| STATE FUNDED PRESCRIPTION PROGRAM | |
| DEATH WITH NO KNOWN ESTATE | |
| PATIENT RECEIVING FREE CARE FROM COMMUNITY CLINIC | |
| PATIENT IS MENTALLY OR PHYSICALLY INCAPACITATED | |
| ELIGIBLE FOR STATE OR LOCAL ASSISTANCE THAT IS UNFUNDED | |
| MEDICAL ILLNESS HARDSHIP | |
| OTHER PLEASE LIST: | |
| HOUSEHOLD INCOME IF KNOWN: |