What is Charity Care?
Patients unable to pay for non-elective products should consult UCH for assistance identifying available resources to meet financial obligations. This Charity Care Policy provides guidelines for financial assistance based on financial need. This financial assistance is only available for non-elective products. The Charity Care Policy is available to patients who are considered private pay. Patients are responsible for providing accurate information and all documentation necessary to apply for UCH’s charity care financial assistance. Both UCH and the patient are accountable for their role in the charity care process.
A. Patient Responsibilities
To be considered for a discount under the Charity Care Policy, the patient must:
- Cooperate with UCH to provide the information and documentation necessary to apply for other existing financial resources that may be available to pay for healthcare, such as Medicaid, third-party liability, etc.
- Provide UCH with all requested information needed to determine eligibility. This includes completing the required application forms and cooperating fully with the information gathering and assessment process.
- A patient who qualifies for a partial discount must cooperate with UCH in establishing a reasonable payment plan for the balance of expenses. A patient who qualifies for a partial discount must make good-faith efforts to honor the payment plans for the discounted bills. Failure to comply with the established payment schedule will result in the balance being turned over to our collection agency. The patient is responsible for promptly notifying UCH of any change in financial status so that the impact of this change may be evaluated against financial assistance policies governing the provision of charity care, the discounted physician bills, or provisions of payment plans.
B. Application Process and Eligibility
- When determining patient eligibility for charity care, UCH agrees to be equitable, consistent and timely. Requests for financial assistance will be accepted up to four (4) weeks from the date the first statement is remitted to the patient.
- Requests may be received from the patient, legal guardian, parent of a minor or incompetent dependent, or spouse.
- 3. Liens attached to insurance (auto, liability, life and health) are permitted.
- Patients requesting financial assistance will be required to complete the Financial Assistance Application Form in order to establish eligibility. Patients may be eligible for charity care if they are uninsured and meet other specific criteria.
- Criteria for which a patient may be eligible for financial assistance are:
(i) Patient is homeless.
(ii) Patient is deceased and has no known estate able to pay hospital debts.
(iii) Patient is incarcerated for a felony.
(iv) Patient is currently eligible for Medicaid, but was not at the date of service.
(v) Patient is eligible by the State to receive assistance under the Violent Crime Victims Compensation Act or Sexual Assault Victims Compensation Act.
(vi) Patient is eligible for Medicaid or other government healthcare program funding for certain emergency health services provided to undocumented aliens in accordance with the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Section 1011, regardless of whether Section 1011 funds for the applicable state are exhausted.
(vii) Patient is deemed to have minimal financial resources based on analysis of the Financial Assistance Application by UCH.
6. The completed Financial Assistance Application Form will be submitted to UCH’s Corporate Office for processing. UCH requires proof of income including employer pay stubs, employer verification and/or IRS tax return summary. In addition, Medicaid or other government healthcare program beneficiaries are subject to an additional asset test in accordance with federal law. This review is completed to determine patient eligibility based on the patient’s total resources (including but not limited to family income level, assets, as required for Medicaid patients and other pertinent information).
In order to qualify for financial assistance under this Charity Care Policy, a patient must satisfy at least one of the following six conditions:
- No third-party coverage is available.
- Third-party coverage is available, but with limited benefits.
- Third-party coverage is denied due to pre-existing conditions.
- Patient is already eligible for assistance (e.g. Medicaid), but the particular services are not covered.
- Medicaid or other government healthcare program benefits have been exhausted and the patient has no further ability to pay. Welfare assistance is denied due to resources and/or income, but the patient is deemed by UCH to be in circumstances in which an illness will make it impossible to meet financial obligations.
- Patient is below two times the most recently available federal poverty threshold requirements.
D. Outcomes Process and Notification
- Financial Assistance approvals will be made according to these Charity Care Guidelines.
- The minimum discount for private-pay payments of non-elective services will be 30%.
- An asset test is mandatory for Medicaid patients. The Medicaid patient is responsible for the greater of: a) Seven percent (7%) of Available Assets (defined as cash, cash equivalent and non-retirement investments) or b) Required payment per the Charity and private-pay Discount Worksheet for Non-Elective services.
- When determining the patient’s income, the household size and income includes all immediate family members and other dependents in the household. This includes an adult (and spouse if applicable), natural or adopted minor children of adult or spouse, students over 18 years of age dependent on the family for over 50% support, and any other persons dependent on the family income for over 50% support. (A current tax return of the responsible adult is required.)
- Income may be verified by submitting a personal financial statement, copies of W-2, 1040 forms, self-employment financial statements, bank statements or any other form of documentation that supports reported income.
- Financial Assistance applications are reviewed by Revenue Services.
- The patient will be notified of eligibility for charity care generally within thirty (30) days of receiving a completed application and all requested documentation.
- If the patient disagrees with the decision, he or she may request an appeal in writing within thirty (30) days of the denial and include any additional relevant information that may assist in the appeal evaluation.
- For those patients who have applied for Medicaid, collection activity will be suspended during the consideration of a completed application.
- This process is a courtesy and does not alleviate the financial obligation.