Patient Assistance Policy
For questions about patient assistance contact:
St. Peter’s Hospital provides financial assistance to persons who have healthcare needs and are unable to pay for necessary services. St. Peter’s strives to ensure that financial issues do not prevent patients from seeking or receiving care.
Patient assistance is not considered to be a substitute for personal responsibility. Patients must cooperate with St. Peter’s procedures for obtaining financial assistance. Patients are expected to contribute to the cost of their care based on their ability to pay. Individuals with the financial means to purchase health insurance shall be urged to do so. This assures access to health care services and protects their assets.
In order to allow St. Peter’s to provide a fair level of assistance to the greatest number of persons in need, the Board of Directors establishes the following guidelines for patient assistance.
Patient Assistance: Healthcare services that have or will be provided but are not expected to be paid. Patient assistance results from St. Peter’s policy to provide healthcare services free or at a discount to individuals who meet this policy’s criteria.
Family: Using the Census Bureau definition, a group of two or more people who reside together and who are related by birth, marriage or adoption. Dependants are defined by Internal Revenue Service rules.
Family Income: Family Income is determined using the Census Bureau definition which uses the following income when computing federal poverty guidelines:
- Includes earnings, unemployment compensation, workers’ compensation, Social Security, Supplemental Security Income, public assistance, veterans’ payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous income sources;
- Noncash benefits (such as food stamps and housing subsidies) do not count;
- Determined on a before-tax basis;
- Excludes capital gains or losses; and
- If a person lives with a family, includes the income of all family members (Non-relatives, such as housemates, do not count).
|2016 Federal Poverty Income Guidelines:|
|Family Size up to:||Federal Poverty Income Level of 100%|
|For each additional family member add $4,160|
Uninsured: The patient has no level of insurance or third-party assistance to aid with meeting his/her payment obligations.
Underinsured: The patient has some level of insurance but still has out-of-pocket expenses that exceed his/her financial abilities.
A. Services Eligible under this Policy. For purposes of this policy, “patient assistance” refers to healthcare services provided without charge or at a discount to qualifying patients. The healthcare services below are eligible for patient assistance. A list of our service providers will be available via the following website link - https://www.stpetes.org/find-a-doctor - and only providers employed by St. Peter’s Hospital are covered under this policy.
1. Emergency medical services provided in an emergency room setting.
2. Services for a condition which, if not promptly treated, would lead to an adverse change in the health status of the individual.
3. Non-elective services provided in response to life-threatening circumstances in a non-emergency room setting.
4. Medically necessary services.
Medically Necessary Care – means a medically necessary service or treatment which is reasonably calculated to prevent, diagnose, correct, cure, alleviate, or prevent the worsening of conditions in a patient which: (i) endanger life; (ii) cause suffering or pain; (iii) result in illness or infirmity; (iv) threaten to cause or aggravate a handicap; or (v) cause physical deformity or malfunction. A service or item is not medically necessary if there is another service or item for the recipient that is equally safe and effective and substantially less costly, including, when appropriate, no treatment at all. Experimental services or services which are generally regarded by the medical profession as unacceptable treatment are not medically necessary. An elective or cosmetic surgery or treatment is not medically necessary.
5. This policy does not apply to the retail pharmacy. Patient assistance for this service is covered under policy #110-0073.
6. This policy covers only charges incurred at St. Peter’s Hospital and St. Peter’s Medical Group.
B. Eligibility for Patient Assistance. Patient assistance will be considered for those individuals who are unable to pay for their care. Eligibility will be based upon a determination of financial need in accordance with this Policy. It shall not take into account age, gender, race, social or immigrant status, sexual orientation or religious affiliation. Patient assistance is secondary to all other financial resources available. Refusal to access other available funding, such as Medicaid, will dis qualify the patient for eligibility under this policy. Patients seeking financial assistance will be afforded 240 days after the first post-discharge billing statement is received for a previously provided visit.
C. Determination of Financial Need.
1. Financial need will be determined in accordance with procedures that involve an assessment of financial need; and may
a. Include an application process, in which the patient or the patient’s guarantor are required to cooperate and supply information and documentation relevant to making a determination of financial need;
b. Include reasonable efforts by St. Peter’s Hospital to explore alternative sources of payment and coverage from public and private payment programs and to assist patients to apply for such programs;
c. Take into account the patient’s available assets and all other financial resources available to the patient; and
d. Include a review of the patient’s outstanding accounts receivable and the patient’s payment history.
2. It is preferred but not required that a request for patient assistance and approval of financial need occur prior to rendering of services. However, the determination may be done at any point in the collection cycle.
The need for assistance shall be re-evaluated at six month intervals or at any time a patient’s financial situation changes.
3. Requests for patient assistance shall be processed promptly. Once an application is received, the individual seeking assistance will be afforded 30 days to submit all necessary documentation before a denial letter is provided for failure to comply with the application requirements. St. Peter’s shall also notify the patient in writing within 30 days of receipt of a completed application. Collection activity will be suspended while a financial assistance application is under review. A note will be entered into the patient’s account to highlight that a patient assistance application is pending.
D. Presumptive Financial Assistance Eligibility. There are instances when a patient may appear eligible for discounts, but there is no financial assistance form on file. Often there is adequate information to determine a need for assistance. Patients that are homeless or deceased with no estate may be presumed to be eligible for patient assistance without the completion of an application. Patients receiving food stamps, section 8 housing, or any other indigent subsidies provided by the state may be eligible with proof of pertinent documentation. These qualifiers would be eligible for 100% write off of the account balance.
E. Patient Assistance Guidelines. Services eligible under this Policy will be made available to the patient on a sliding fee scale as described in this section; additionally, extended payment plans based on patient’s ability to pay are subject to disposable income verification and will be processed on an individual basis.
1. Patients whose family income is at or below 175% of the Federal Poverty Level (FPL) are eligible to receive free care.
2. Patients whose family income is above 175% but not more than 250% of the FPL are eligible to receive a discount of 50% of their account balance. This discount exceeds amounts generally billed (AGB) from Medicare, Medicaid and all private insurance. Our finance department will compute AGB once per year in accordance with 501r compliance.
3. St. Peter’s may offer several extended payment plan options to eligible patients under E.2. and will not impose derogatory credit reporting, wage garnishments or liens on primary residences while such payment plans remain in good standing.
For more information, please refer to St. Peter's Patient Assistance Eligibility Guidelines.
F. Medical Hardship. St. Peter’s Hospital will limit the amount of medical debt that a patient can incur in a 12 month period to 25% of household income. Medical debt includes all medical costs for which St. Peter’s billing office is responsible to bill. Patients whose household income exceeds 700% of FPL are ineligible and will be evaluated on a case-by-case basis.
G. Household Assets. Household assets may be included in the calculation of eligibility for assistance. A patient’s primary residence, retirement assets (as defined by the Internal Revenue Service) and the patient’s primary automobile are excluded from the calculation of household assets. In addition, the first $5,000 is excluded and the balance of net household assets will added as an additional income source to the patient’s yearly family income referred to in section E above.
H. Communication of the Patient Assistance Program to Patients and the Public. Notification about financial assistance from St. Peter’s Hospital shall be communicated by various means. These may include the publication of notices in patient bills and by posting notices in the emergency room, physician offices, admitting, the cashier window and other public places that St. Peter’s may elect. This Policy will also be posted on the St. Peter’s website. Referral of patients for financial assistance may be made by the patient, a family member, or friend of the patient and any member of the St. Peter’s staff or medical staff.
I. Relationship to Collection Policies. St. Peter’s Hospital management shall develop policies and procedures for internal and external collection practices that take into account the extent to which the patient qualifies for financial assistance, a patient’s good faith effort to apply for a government program or for assistance from St. Peter’s, and a patient’s good faith effort to comply with his or her payment agreements with St. Peter’s. For patients who qualify for assistance and who are attempting to resolve their hospital bills, St. Peter’s will not engage in any extraordinary collections act (ie. impose derogatory credit reporting, wage garnishments or liens on primary residences) and will not charge interest on outstanding balances.
J. Administration. This policy shall be administered by the Director of Patient Business Services and the Director of Physician Billing.
|Patient Assistance Application||97.16 KB|
|Customized Payment Plan Form||60.73 KB|