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Financial Assistance Program Summary
Effective April 1, 2007
 
Uninsured 100% Financial Assistance
Patient responsible for 0% of Medicare payment amount
  • Requires MA application and/or MA denial.
  • Requires Patient Financial Statement and proof of income.
  • Catastrophic medical event
  • Approval based on income less than 200% of Federal Poverty Guidelines (FPG), assets and financial need.

Note: If patient is uninsured and refuses to apply for MA the total patient income will be assumed to be a minimum of 201% of FPG regardless of actual income.

Uninsured Financial Assistance
Patient responsibility for 25% - 100% of Medicare payment amount
  • Patient is uninsured and income is greater than 200% of Federal Poverty Guidelines (FPG).
  • Requires Patient Financial Statement and proof of income.
  • Approval and amount of assistance determined by income, assets and financial need.
  • Catastrophic event
  • No other discounts or reductions are applicable.

 
Underinsured 100% Financial Assistance
Patient responsible for 0% of Medicare payment amount
  • Patient is insured and income is less than 200% Federal Poverty Guidelines (FPG).
  • Requires Patient Financial Statement and proof of income.
  • Catastrophic event
  • Approval based on income less than 200% of Federal Poverty Guidelines (FPG), assets and financial need.
  • Patient will not pay more than an uninsured patient.
  • No other discounts or reductions will applicable toward the patient residual amount.

 
Underinsured Financial Assistance
Patient responsible for 25% - 100% of Medicare payment amount
  • Patient is insured and income is greater than 200% Federal Poverty Guidelines (FPG).
  • Requires Patient Financial Statement and proof of income return.
  • Approval and amount of assistance determined by income, assets and financial need.
  • Catastrophic event
  • Patient will not pay more than an uninsured patient.
  • No other discounts or reductions will applicable toward the patient residual amount.
 
Notes:
If patient is uninsured and refuses to complete Patient Financial Statement, income will be assumed to be a minimum of 401% of Federal Poverty Guidelines(FPG) regardless of actual income and will be eligible for 25% Financial Assistance discount.

If patient is insured and refuses to complete Patient Financial Statement, income will be assumed to be a minimum of 401% of Federal Poverty Guidelines regardless of actual income and will only be eligible for the 5% Prompt Pay Discount (Co payments due at the time of service and Medicare and Medicaid patients are excluded from Prompt pay Discount).