Financial Assistance Policy
It is our commitment to provide quality health care
services with compassion, dignity, and respect for those we serve,
especially the poor and underserved. We will provide low-income
individuals with financial assistance based upon established guidelines.
Scope of Policy
Recording of Financial Assistance
Financial Assistance Free or discounted
health services provided to persons who cannot afford to pay.
It may include those persons who are uninsured or underinsured
and/or not eligible for any private or public underwritten health
care coverage program based on government or internal determination.
Individuals qualifying for Financial Assistance must meet pre-established
Family A household that resides in
a defined residence or has no residence but operates together
as a unit. The family unit may include parents or other elderly
relatives of those in the family unit that are defined as dependents
on the Federal Tax return.
Family Income Family income may include
all income attributable to all members of the family in the defined
residence, other than minimal amounts earned by minors.
Earned and Unearned Income Earned
income includes salary, wages, self-employment income, and tips
earned by the patient, spouse, or parent. Also included is unearned
income received from Social Security, disability payments, retirement
benefits, child support, alimony, interest earnings, dividends,
and income from other sources (unemployment, workers compensation,
Assets Assets that will be considered
liquid include those that could be converted to cash within one
year. These include checking accounts, saving accounts, trust
funds, and other investments. Additionally, countable assets include
the liquidated value of luxury items, i.e., recreational vehicles,
second homes, etc. In lieu of liquidating the assets, they may
count as current years income when determining what level of financial
assistance should be provided.
Scope of Policy
A. Financial assistance applies to all patients
regardless of race, creed, sex, age, or payor.
B. Eligibility for financial assistance will be
determined on an individual basis and evaluated on an assessment
of the patient's and/or family's need, financial resources, and
C. Financial assistance applies to all types of
medically necessary services.
D. Services not provided or billed by the hospital
are not covered by this policy.
E. Trauma/emergency care will be provided to all
patients, regardless of their ability to pay. Stabilization of
the patient will occur prior to any determination of payment arrangements.
F. Cosmetic services and other elective procedures
should not be underwritten by financial assistance.
G. In general, financial assistance should not be
provided to residents out of the service area unless the patient
presents with an urgent, emergent, or life-threatening condition.
A. A financial assistance determination will be
made once the application (see attachment I) has been completed
and approvals have been received. A completed application will
serve as the basis for documenting the patient's eligibility for
assistance in accordance with pre-established criteria.
B. A financial assistance process will be utilized
for evaluating the patient's financial resources and obligations.
The assessment process requires that the patient provide the following
information as considered appropriate:
- Earned income including monthly gross wages, salary, and self-employment
- Unearned income including dividends, interest and income from
any other source such as unemployment or workers compensation.
- Number of dependents in the household.
- Information to determine the patient's financial status, including
assets and liabilities.
(Note: Supporting documents will be requested and will be filed
with the application.)
C. Proxy Information It is appropriate
to use proxy information to determine financial assistance eligibility.
For example, the fact that the applicant "stays with friends"
or works "occasionally" are good proxies for determining
D. Offsets to Income Out-of-pocket
outlays of income required to meet a family's health and medical
care needs may be subtracted from the patient's income. These
may include out-of-pocket prescription drugs, health care coverage
premiums, caregiver services, and the like. In addition, tuition
and education fees may also be subtracted.
E. Efforts should be taken to determine a patient's
eligibility for financial assistance at or before the time of
admission or service; however, determinations can be made after
service and should be considered prior to taking legal action
F. Reasonable measures will be taken to ensure that
any language or hearing barriers are addressed.
G. In general, a multiple of federal poverty guidelines,
minimum of 100% maximum of 200%, is the appropriate basis for
the initial determination of a patient's eligibility for financial
assistance. However, other factors stemming from the patient's
financial application will also be taken into consideration. It
should be assumed that individuals in families with income at
or below the poverty level do not have the ability to underwrite
their health care needs.
H. Income will be re-verified every six (6) months
one (1) year based on need. It will be appropriate to retroactively
determine financial assistance eligibility based on this re-verification.
I. Patients may also be eligible for financial assistance
for a portion of their account. A sliding scale will be used to
determine the percentage of financial assistance available to
the patient. Financial assistance may be used for co-pays and
deductibles, and when the patient is not able to pay for the entire
amount of their account.
J. Approval levels for financial assistance will
be as follows:
- $0 - $4,999 Manager of Patient Accounts
- $5,000 - $9,999 Director of Patient Administration
- $10,000 plus Chief Financial Officer
K. Financial assistance should be made in accordance
with the predetermined criteria. However, it is recognized that
occasionally there will be a need for granting financial assistance
to a patient who may otherwise not meet the criteria established
within the procedure. In such cases, the Manager of Patient Accounts
and/or the Director of Patient Administration Services will review
the case and document why the assistance was granted. This documentation
will be maintained in the financial folder.
L. Documentation of financial assistance must be
kept on file for a minimum of seven (7) years. Documentation of
financial assistance should also be noted in the patient's account.
A. The following areas will be considered as eligible
for financial assistance classification within the financial statements.
- Unreimbursed medically necessary services provided
to patients qualifying for federal, state or county federal
- Denied Medicaid (or other publicly sponsored
program) services when there is no other coverage source (non-covered
- Medicare deductible and co-insurance dollars
otherwise not paid by Medicaid and not reimbursed by Medicare
through the cost report.
- Settlement arrangements with patients at less
than full amount due because of patient's inability to pay full
balance (amount forgiven would be classified as charity).
- Patient bankruptcies
- Sexual assaults/victims of crime.
- Accounts initially written off to bad debt and
subsequently returned from collection agencies where the patient
was determined to have met the financial assistance criteria
based on information obtained by the collection agency.
- Returns from a collection agency requested by
the hospital where charity guidelines are met within six (6)
months of bad debt turnover date.
It is recognized that not all patients will be willing
or able to provide complete financial and/or social information.
Therefore, some charity cases may be determined based on available
- Patient is deceased with no known estate.
- Patient is homeless or unemployed
- Family/friend provides undocumented information
establishing the patient's inability to pay.
- Members of religious organizations who have taken
the vow of poverty.
- Patients with current eligibility under county
or state medical indigent services administered by county or
state facilities or private sector entities.
Recording of Financial
A. Financial assistance must be valued at the cost
of providing the care, in accordance with the Healthcare Audit
Guide and Trinity Health Policy.
B. Financial assistance must be systematically accounted
for so that the community benefit component is accurately recorded.
If you are a Mercy Hospital Grayling patient and have
a compliment, concern, or complaint, please contact one of our Patient
We welcome your comments and suggestions about this Web site.