Charity Care/Financial Assistance is intended to assist those low-income individuals who do not otherwise have the ability to pay full charges or need assistance with co-insurances and deductibles for medically necessary services. When patients are unable to meet their obligations, and they demonstrate the need, the hospital will assist the patient (guarantor) in accordance with its not-for-profit charitable mission. This assistance can be in the form of financial counseling, payment arrangements or the offering of charity care/financial aid. Should the patient (guarantor) not be able to demonstrate a true need, and no effort is being made to settle their account(s), the hospital will have no recourse but to recommend that the account be turned over to a collection agency. The hospitals catchment area for charity care/financial aid includes the counties Allegany, Cattaraugus, Steuben Livingston and Wyoming in New York and Potter and McKean counties in Pennsylvania.
Charity Care/Financial Assistance: Charity Care/Financial Assistance will be provided to low income individuals - those below 300% of the Federal Poverty Level – utilizing collection practices that recognize the limited financial capacity of these individuals.
How Do I Qualify?
In order to qualify for financial assistance the patient or their representative must apply to the hospital within ninety days of the date of service or date of discharge. As a condition of seeking financial assistance, patients will be required to apply for Medicaid (eg, Traditional Medicaid, Family Health Plus, Child Health Plus and Prenatal assistance programs) unless it is clear that the patient will not be found eligible for such assistance or if filing for such assistance is against the religious beliefs of the patient. The criteria that will be used by the hospital for those patients (guarantors) who apply for medicaid will be a sliding fee schedule based on Federal Poverty Guidelines (see attached Schedule 1). The patient (guarantor) will be required to provide information about their income level and number of people living in the household and documentation to verify this information. The forms for income verification are listed in the application packet. Consideration will be given on a case by case basis to patients (guarantors) who have exhausted their insurance benefits and/or who exceed financial eligibility criteria but face extraordinary medical costs. Charity Care/Financial Assistance is not a substitute for employer-sponsored, public or individually purchased insurance. All uninsured patients receiving services at Jones Memorial Hospital and the Jones Memorial Physician Practices will receive a 50% discount prior to the charity care process, as part of the Hospitals financial aid program.
Who Can Help Me Apply?
The hospital has available to the patient (guarantor) a Patient Financial Consultant that will direct them on how to apply for Medicaid and other low-cost insurance programs. If the patient does not qualify for the programs available to them, he will send them the application for financial assistance. At this time he will inform them what documentation he will need to see and will help them in the application process. After the application is completed and we have the necessary documentation he has thirty days to inform the patient if he has been approved and the level of discount they will receive. This must be done in writing to the patient.
What Services Are Covered?
All medically necessary services provided by Jones Memorial Hospital are covered by the program. This includes outpatient services, emergency care and inpatient services. Financial Assistance is available to all residents in Allegany, Cattaraugus, Livingston, Steuben, and Wyoming counties in New York plus Potter and McKean counties in Pennsylvania. Charges from private doctors who provide services in the hospital may not be covered and include such doctors as the emergency room physicians, radiologist and any non-employed physician on staff at Jones Memorial Hospital.
Is There A Payment Plan?
The hospital will incorporate flexible payment plans as appropriate. A monthly payment capped at 10-percent of the patients /household’s total gross income can be required by the hospital on a monthly basis. Multiple bills for the same family or household could be capped individually at 10% of the total gross income for each separate bill.
Nonpayment of the agreed upon monthly amount will be considered a default of payment and the unpaid balance will be due immediately. The patient will receive a series of statements from the hospital requesting payment. If no activity takes place on the account, a final letter is sent to the patient (guarantor) stating that the account will be turned over to an outside collection agent. If an account remains unpaid and there is no visible attempt by the patient (guarantor) to pay the account, the hospital will have no recourse but to refer the account to outside collection.
All financial aid applications will be subject to approval by the hospitals financial counselor. A patient/guarantor who’s receives a denial on his/her application for financial aid has the ability to appeal the decision which will be reviewed and acted on by the hospitals Chief Financial Officer.
Previously revised: April 23, 2009 October 28, 2009
Financial Aid/Charity Care Program
Based on 2012 Rates
ANNUAL MONTHLY WEEKLY
Claims<=100-percent of the federal Poverty Guidelines will require the following payment by the patient/guarantor:
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