This policy addresses the discounting or free care of Magee Rehabilitation Hospital charges to uninsured patients. This policy does not apply to patients who are "underinsured" as opposed to uninsured; for example, it is not the intent of this policy to require free or discounted care to patients who have health insurance coverage with high deductibles or coinsurance.

PURPOSE:

In accordance with Magee Rehabilitation Hospital's mission, discounted rates or free care are provided to patients who are uninsured and who do not qualify for Federal or State healthcare benefits.

Definitions:

Charity Care means the ability to receive free care. Patients who are uninsured for the relevant, medically necessary service, who are ineligible for governmental or other insurance coverage, and who have family incomes not in excess of 200% of the Federal Poverty Level will be eligible to receive free care (See attached Schedule A).

Financial Assistance means 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 Federal Poverty Level, will be eligible to receive Financial Assistance in the form of a partial discount off charges (See attached Schedule A).

Uninsured Patient means an individual who does not have any third-party healthcare coverage by: (a) a third party insurer, (b) an ERISA plan, (c) a Federal Healthcare 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.

POLICY:

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

At the same time the patient or patient representative will be interviewed to determine if the patient would qualify for a discounted self pay rate or free care.

The demographic information to be gathered should include but is not limited to names, birthdates and social security numbers of all family members for whom the patient has financial responsibility.

The financial information to be gathered should include but is not limited to W-2s for all income earners in the household, tax returns, proof of residence, checking account and savings account statements and any other documentation required to help determine the patient's eligibility for this program.

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.

Magee Rehabilitation Hospital personnel will calculate the financial liability of an Uninsured Patient based on the Uninsured Patient's household income and family size. Personnel shall use the Magee Rehabilitation Hospital Charity Care and Financial Assistance Grid and/or Worksheet (Attached as Schedule A) when calculating the Uninsured Patient's financial liability.

Applications which do not meet all of these guidelines may be approved based upon extraordinary circumstances with the documented approval of the Magee Rehabilitation Hospital COO or CFO. It is recognized that there is a small percentage of the uninsured patient population that has substantial assets and could easily afford to pay for healthcare services, but who, because of having tax-exempt income or otherwise, will not have income reflected on a tax return. This policy is not intended to apply to this portion of the uninsured patient population.

Collection of amounts due from patients receiving Charity Care or Financial Assistance shall be handled pursuant to the Magee Finance Policy on Collections.

Originating Source: Patient Accounting
Revised Date: 5/27/05
Effective Date: 1/1/05

Schedule A
Magee Rehabilitation Hospital Charity Care and Financial Assistance Table*
To apply for Charity Care and Financial Assistance, the patient must complete the Magee Charity Care Application and proof of income must be attached.

Add $3,740 for each family member over 8 members
*This Table shall be adjusted in accordance with annually released changes to the Federal Poverty Levels