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Uninsured/Under Insured Insurance Counseling


PURPOSE:

To acknowledge in written policy the existing practice and responsibility of this organization under section 501(c) (3) of the Internal Revenue Code to provide care, consistent with the scope of services provided by this organization, to indigent persons regardless of their ability to pay. This policy will define a process for determining the eligibility of a patient for receiving financial assistance for health care services.

POLICY:

LPRH, as an integral part of our health promotion mission and community benefit responsibility, shall provide financial assistance to patients in need. Necessary clinical evaluation and care shall not be delayed, limited, withheld or withdrawn in order to inquire about or to determine eligibility for financial assistance, or based upon a determination that the patient does need such services.

See the policy below. The hospital offers 30 - 50% discounts based on insurance coverage and income requirements.

To request an application contact the Business Office Director at:yholt@lapazhospital.org




PROCEDURE: (DETERMINATION OF NEED)

Admitting personnel, including our clinics will, through normal admitting procedures, determine eligibility by interviewing the patient and make all patients aware of the existence of LPRH financial assistance availability. Once the questions below have been answered, admitting personnel will provide the patient with an application which must be returned with all supporting documentation. Completed applications will be forwarded to the Business Office Director for review and then forwarded on to the CFO/CEO for final approval.

Questions:
  • Patient does or does not have health insurance coverage
  • Patient states they do not have income (Current Year Federal Poverty Guidelines, Attached)
  • Patient is not eligible for AHCCCS, Medicaid, Medi-Cal, is disabled or eligible for any other Program for assistance.

La Paz Regional Hospital, a not for profit organization exempt from federal and state taxes and as the sole hospital in La Paz County, recognizes it is obligated to provide healthcare services to all individuals without regard to their ability to pay for those services. In addition, the hospital recognizes that there are individuals who have neither the income nor assets to obtain private health insurance coverage or to pay out-of-pocket for healthcare services. Therefore, it is the policy of this hospital to provide financial assistance or grant forgiveness related to portions of the debt incurred by patients who apply for financial assistance and who fall within the established financial criteria.

Eligible patients will be those described in the first paragraph whose annual household income does
not exceed 250 percent of the current year Poverty Income Guidelines published by the United States Department of Health and Human Services (attachment A). Any uninsured patient will be eligible for a 30% reduction in charges as a recognition of their need for financial assistance, with a potential for a greater consideration as follows. Patients whose household income falls at or below the poverty guidelines will be potentially eligible for a 50% reduction in charges. Patients whose household income is greater than 100 percent but less than 151 percent of the poverty level will be potentially eligible for a 45% reduction in charges. Patients whose household income is greater than 151 percent but less than 201 percent of the poverty level will be potentially eligible for a 40% reduction in charges. Patients whose household income is greater than 201 percent but less than 251 percent of the poverty level will be potentially eligible for a 35% reduction in charges.
Patients may apply for the financial assistance program at any time having been notified of their potential eligibility. The hospital shall require proof of income and reserves the right to adequately verify the information submitted by the individual requesting assistance.

Patients who have very high deductible health insurance coverage, who are responsible for the total bill as it falls under the deductible must; nevertheless, meet the guidelines of Section A below.

In recognition of the need for the hospital to generate net income sufficient to sustain operations, annual combined bad debt and financial assistance in excess of six (6) percent of hospital gross income will be cause for the financial assistance program to be reviewed, and possibly adjusted. The hospital's audited year end financial statements will report patient revenue net of financial assistance reductions as called for in the current hospital audit guide.

ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE (CHARITY CARE PROGRAM):


A: Patient has health insurance coverage:

INCOME:
DISCOUNT:

At or below 2015 Federal Poverty Guideline: 50%
At or below 150% of the Federal Poverty Guideline: 40%
At or below 200% of the Federal Poverty Guideline: 30%
At or below 250% of the Federal Poverty Guideline: 0%
Above 250%: None

B: Patient has no health insurance coverage:

INCOME:
DISCOUNT:

At or below Federal Poverty Guideline: 50%
At or below 150% of the Federal Poverty Guideline: 45%
At or below 200% of the Federal Poverty Guideline: 40%
At or below 250% of the Federal Poverty Guideline: 35%
Above 250% 30%

A greater discount may be allowed by Administration based upon recommendations from BOM and CFO.

RECORD KEEPING:

The Business Office will keep detailed records of all Financial Assistance Program requests and approvals.

ATTACHMENTS:
2015 Federal Poverty Guidelines Application for Financial Assistance Program
This attachment will be updated yearly or sooner based on the Federal Government updating or changing this guideline.