Financial Assistance Full Policy

Purpose:

In accordance with Magee Rehabilitation Hospital’s mission, Magee Rehabilitation Hospital (Magee) considers each patient’s ability to pay for his or her medical care and is committed to treating patients who have financial needs with the same dignity and consideration that is extended to all of Magee’s patients.  Magee intends, with this policy, to establish financial assistance procedures that are compliant with applicable federal, state and local laws.

Scope of the Policy

This Policy shall cover medically necessary health care services provided by Magee’s Inpatient and Outpatient but does not include non-employed physician and other services provided by outside vendors.  It is not the intent of this policy to offer free or discounted care to patients who have health insurance with high deductibles or coinsurance unless they otherwise qualify for Financial Assistance under this Policy.  Any person who does not have insurance or does not have the ability to pay all or part of their financial responsibility to Magee for services provided by Magee may apply for Financial Assistance.  Patients who are receiving elective services are not eligible.

Definitions:

Charity Care: 100% free medical care for medically necessary services provided by Magee. Patients who are underinsured or uninsured for a medically necessary service, who are ineligible for governmental or other insurance coverage, and who have family income not in excess of 200% of the Federal Poverty Level (FPL) will be eligible to receive charity care (See attached Schedule A).

Presumptive Charity Care:  A determination that a patient is presumed eligible for Charity Care based on financial and historical qualifiers.

Financial Assistance:  the ability to receive care at a discounted rate.  Patients who are uninsured for the relevant service and who are ineligible for governmental or other insurance coverage, and who have family incomes in excess of 200%, but not exceeding 500%, of the FPL, will be eligible to receive Financial Assistance in the form of a partial discount off charges.  (See attached Schedule A)

Patients who are uninsured, ineligible for free governmental coverage if available, and have family incomes in excess of 200% but not exceeding 300% of FPL, should be eligible to receive discounted care at no more than 30% of billed charges (i.e. at least a 70% allowance) or, to the extent the Patient Protection and Affordable Care Act (PPACA) limits amounts charged to such patients to less than 30% of billed charges, the PPACA limit, provided they cooperate as aforesaid. Discounts or allowances against billed charges should also apply to eligible patients between 300% and 500% of FPL; provided however, to the extent the PPACA limit applies to such patients, the amounts charged to such patients shall not exceed the PPACA limit. Additional discounts or allowances for prepayment, prompt payment, or agreement to a payment schedule may be offered, provided they are uniformly applied. A member may decide by policy that patients who would otherwise be eligible for discounted care based on income between 200% and 500% of FPL but who have sufficient available assets to pay for services at full charges without becoming medically indigent are not eligible for discounts or allowances. (See Schedule A).

Medically Indigent: Patients who, despite their income, have a low level of liquid assets such that payment of their medical bills would be seriously detrimental to their basic financial wellbeing and survival.

Uninsured Patient: An individual who does not have any third-party health care coverage by: (a) a third party insurer, (b) an ERISA plan, (c) a Federal Health Care Program (including without limitation Medicare, Medicaid, SCHIP and TRICARE), (d) Workers’ Compensation, Medical Savings Accounts or other coverage for all or any part of the bill, including claims against third parties covered by insurance to which Magee is subrogated, but only if payment is actually made by such insurance company.

Underinsured Patient: An individual who has medical insurance coverage that is limited in the scope of covered services or policy maximums such that his or her medical bills are not fully covered.

Federal Health Care Program means any health care program operated or financed at least in part by the federal, state or local government.

PROCEDURE:

Eligibility: Any person who does not have insurance or does not have the ability to pay all or part of their financial responsibility to Magee for Magee provided services.

Eligibility Determination

Inpatient Admissions: All patients admitted to Magee who are uninsured will have a state specific medical assistance application taken to determine if they are eligible for medical and hospital payment benefits.

  • Medical Assistance eligibility/denial notice from the State of Pennsylvania and/or County Services for Inpatient admissions
  • Income Tax returns for the most recently filed year.
  • Proof of income and Adjusted Gross Income such as:
  • Pay stubs from the past six (6) pay periods
  • W-2 withholding statement
  • Social Security checks, receipts or deposits
  • Bank statements – checking and savings
  • Any other documentation that may serve as proof of Charity Care or Financial Assistance eligibility.

The financial resources of a parent or guardian may be considered in determining the eligibility of a patient who is dependent on the parent or guardian for financial support.

Participation

Patients will not be eligible for free or discounted care unless they cooperate in a timely manner with the application process and efforts to help secure available free governmental coverage. 

Application for Eligibility

A completed Charity Care and Financial Assistance Application will be forwarded to Magee’s Patient Accounting Department.  When the Application for Charity Care is received, the staff will review and determine (through the use of the Charity Care and Financial Assistance Worksheet) if the application is complete and whether the documentation supports Charity Care or Financial Assistance eligibility.

If the patient’s income is 200% below the Federal Poverty Guidelines and the patient provides documentation as determined by the Magee’s Patient Accounting Department, the patient may then become eligible for 100% Charity Care. 

Patients extended Financial Assistance in the form of a partial discount must sign a written agreement to pay the balance remaining after deducting the discount.  The Financial Assistance partial discounts are set forth in Schedule A.  The patient will receive a bill showing charges, the amount of the discount and the balance due.  Non-employed physician and other services provided by outside vendors are not covered by this policy and patients seeking a discount for such services should be directed to call the physician or outside vendor directly.

Patients who do not provide the requested information necessary to completely and accurately assess their financial situation and / or who do not cooperate with efforts to secure governmental health care coverage will not be eligible for Charity Care or Financial Assistance.  However, in normal circumstances, such cooperation should not be a precondition to the receipt of medically necessary treatment, especially emergency care.

Uninsured patients will be eligible for a discount based on the following guidelines:

For the purpose of calculating the discount or free care the base daily per diem will be the most current Pennsylvania Medical Assistance daily per diem rate for inpatient services and Pennsylvania Medical Assistance Fee Schedule for outpatient services. The amount of discount will be determined by using a sliding scale calculation based on the most current federal poverty guidelines found on the Centers for Medicare and Medicaid Services web site. (See attachment A)

Guidelines for Payment Collections

The following collections guidelines should apply to all uninsured patients, whether or not the patient has established eligibility for free or discounted care. All internal employees and outside vendors (including law firms) should be informed of and bound by Magee’s specific collection policies.

  1. Payment will not be pursued in a manner that would make the patient indigent if successful. Generally, absent significant available assets, annual patient payments toward billings that are unreasonable in relation to annual net family income (income less expenses) should not be sought.
  2. Lawsuits or other extraordinary collection actions such as the referral to third party debt collectors or reporting to credit agencies, should not be instituted unless reasonable efforts to determine if a patient qualifies for free or discounted care under Magee’s policies have been made and adequate written opportunity to resolve the unpaid amount have been ignored or rejected. The Chief Executive Officer (CEO) pre-approval of all lawsuits should be required, and it is recommended that Magee cooperate to establish uniform criteria with respect to collection litigation issues.
  3. The placing of a lien on or the seizure of property, or the garnishment of wages, should not be permitted for patients where there is no reasonable belief that there is either income or assets available to fulfill the payment obligation.
  4. The sale or foreclosure of a primary residence with a market value of less than $250,000 shall not be pursued except in special circumstances approved in writing by the CEO.
  5. Where appropriate under applicable law, debt collection may be pursued against financially responsible family members.

Schedule A

Magee Rehabilitation Hospital Charity Care and Financial Assistance Table*

Size of Family Unit2017
100%
FPL
2017
200%
FPL
2017
300%
FPL
2017
400%
FPL
2017
500%
FPL
1$ 11,880 $ 23,760$ 35,640$ 47,520$ 59,400
2$ 16,020$ 32,040$ 48,060$ 64,080$ 80,100
3$ 20,160$ 40,320$ 60,480$ 80,640$ 100,800
4$ 24,300$ 48,600$ 72,900$ 97,200$ 121,500
5$ 28,440$ 56,880$ 85,320$ 113,760$ 142,200
6$ 32,580$ 65,160$ 97,740$ 130,320$ 162,900
7$ 36,730$ 73,460$ 110,190$ 146,920$ 183,650
8$ 40,890$ 81,780$ 122,670$ 163,560$ 204,450

Add $4,160 for each family member over 8 members