As part of our mission, St. Vincent’s Health System (STVHS) provides care to patients having financial or medical need, as defined in this policy, at reduced cost to those patients. This financial assistance is granted to patients based on this policy. A patient of STVHS will not be refused medically necessary care based on their ability to pay.
Financial Need: see Section III. A. of this policy
Medical Need: see Section III. B. of this policy
Financial Adjustment: adjustment of balance owed based on either financial or medical need as defined in this policy
Medically Necessary Care: medically necessary care is defined by either (1) Federal EMTALA law, or (2) determination of STVHS physicians and administrators.
Financial Assistance Application Guidelines:
A. Financial Assistance is available for medically necessary services. Non-essential services are not considered for financial assistance (for example: cosmetic service, maternity services, bariatric services, plastic services, or balances due as a result of contracted services or services deemed non-emergent by review of a Medical Director and recommendations made to Senior Finance staff).
B. Applicants need to be aware that falsifying information on the application will be grounds for denying or revoking financial assistance. Falsifying an application includes, but is not limited to, failure to disclose assets that are not needed for daily living costs and are easily convertible to cash (these would include stocks, bonds, CDs, mutual funds investments that are not needed for daily living expenses).
C. Applicants are required to complete and sign the financial assistance application provided by STVHS. When a signed application is not available, completion of the application via the phone will be witnessed by two STVHS associates. The application focuses on identifying the size of the family unit and financial information that is sufficient to determine if the applicant qualifies for financial assistance. The financial information requested includes, but is not limited to, monthly income and expenses, as well as assets (easily convertible to cash and not necessary for daily living costs) and liabilities. This application will be on file and in effect for a period of 12 months from the date received and accepted as complete by STVHS. The application will be applicable to all balances for medically necessary services owed at the time the application is approved.
D. The applicant will be asked to provide proof of gross household income such as copies of the following:
E. Applicants who are homeless will be offered financial assistance based on lack of third party coverage and having no assets easily convertible to cash and not necessary for daily living costs. The financial counselor will attempt to contact the shelter where the patient is resident if possible. A credit check will be run to confirm the patient’s residence and financial situation.
F. Applicants are invited to submit any additional documentation they feel may be useful in the evaluation and determination process including information detailing permanent or severe illness, extenuating circumstances, and expenses such as prescription drugs, child care, and alimony/child support.
G. If applicable, the patient’s insurance will be filed and payment will be received from the insurance company before determining whether any financial assistance adjustment should be made. Failure of an applicant to cooperate with claims filing, or collecting from a potential third party resource, will be grounds for denying financial assistance.
H. Hardship charity may be awarded on an individual basis for extenuating circumstances as determined by the Financial Counselor and approved by the appropriate level of management described below. The award of hardship charity will be approved per incident and reviewed with each subsequent visit. Supporting documentation for hardship charity requires an application, a supporting document of some type indicating a need for hardship charity such as a letter from a homeless shelter, a letter from someone providing sole support etc, and a credit check.
I. Financial Assistance will only be granted for patients with existing account balances or future visits. Charity will be granted for medically necessary services for 12 months after the date of the charity application approval and for all open balances for medically necessary services at the time of approval.
J. Approval for charity care at one STVHS facility will be valid at all STVHS facilities for the approval period.
K. Approval for charity care may be considered at the guarantor level. When the patient is not the guarantor, STVHS will require additional documentation showing that the patient is receiving most of their support from the guarantor. An example would be a dependent on a parent’s tax return or the same address on the patient’s driver’s license as the guarantor.
L. STVHS reserves the right to use credit scores to verify the need for Financial Assistance and grant adjustments.
II. Financial Assistance Procedures:
A. When hospital personnel identify patients that may need Financial Assistance (based on inability to pay), these patients are referred to the Financial Counselor or Representative. An appointment with the patient is scheduled if the Counselor is not immediately available.
B. The Financial Counselor or Representative counsels with uninsured patients to determine the level of financial need and to determine payment arrangements prior to services if possible. If the patient’s situation appears to meet the financial assistance guidelines, an application for financial assistance is initiated.
C. The Financial Counselor or Representative reviews uninsured patients to identify possible financial assistance candidates. A Financial Assistance Application is initiated where applicable.
D. Every attempt will be made to assist the uninsured patient in becoming covered under available assistance programs, state, local, federal or community based, etc. If an individual refuses to provide the information needed to apply for available insurance coverage, they may not be considered for Financial Assistance.
E. When a financial assistance application is initiated, the Financial Counselor or Representative advises the applicant of the supporting documentation that is required before the application for financial assistance will be considered.
F. The Financial Counselor or Representative will follow up on incomplete financial assistance applications within 2 weeks of the initial application. If supporting documentation that is sufficient to make a determination is not submitted within 30 days of the application, the request for financial assistance may be denied and the account will continue through the collection cycle.
G. When all data is received, the Financial Counselor or Representative reviews the application, completes the financial assistance forms, and indicates the recommendation for approval or denial on the application. The application is given to the appropriate individuals based on the account balance and amount of financial assistance adjustment requested.
H. Approval authority for financial assistance and discounts for the uninsured and underinsured is based on the following criteria: (1) Manager of Patient Access/ may approve adjustments up to $10,000 (2) Revenue Cycle Director may approve adjustments up to $ 100,000, (3) Vice President of Revenue Cycle and/or Vice President of Finance may approve adjustments above $100,000.
I. Once the necessary signatures are completed and approval or denial is confirmed, the Financial Counselor sends the patient a letter informing them of the decision.
J. The Financial Counselor or Representative records the approval or denial in the computer system. In the case of a denial, the Financial Counselor indicates the reason for the denial. The Financial Counselor will also document in STAR when the letter was mailed to the patient.
K. If the application is approved, the patient should agree to payment arrangements on the remaining balance of their account with the Financial Counselor or Representative, and/or appropriate collection agency.
L. All documents pertaining to the Charity Application will be scanned to the SOVERA document imaging system. These documents will be scanned to the “charity” tab and viewable by individuals with designated security access. The documents will be maintained at the MPI rather than account level for a patient.
M. Once approvals have been obtained the patient information will be sent to the business office so the adjustment can be processed. The designated business office employee will also confirm that the letter to the patient has been sent before processing the adjustment.
III. Financial Assistance Standards:
A. Financial need is defined in this policy if the guarantor’s (person responsible for payment) annual household income meets the following criteria:
The Federal Poverty Level (FPL) as published annually in the Federal register will be the basis for guidelines used to qualify applicants. Based on gross income and family size, applicants will be eligible for financial assistance as follows:
100%- 200% FPL Base = 100% adjustment of charges
201%- 250% FPL Base = 90% adjustment of charges
251%- 300% FPL Base = 80% adjustment of charges
B. Medical Need is defined in the policy to be for applicants with income exceeding FPL guidelines and meeting the following criteria:
If the total outstanding medical debt for services provided at STVHS facilities exceeds 20% of the guarantor’s (the person responsible for payment) documented gross household income for the past year, the guarantor will be eligible for a financial assistance adjustment of 100% of all balances exceeding 20% of gross household income.
C. The Vice President of Revenue Cycle is responsible for monitoring the Federal Poverty Levels, and for updating and publishing the Income Criteria Table on which this policy is based. The updated Income Criteria Table will become effective automatically on the first of the month following publication.
D. The Vice President of Mission Services is empowered to authorize financial assistance care in special circumstances where as a judgment call on privileged and confidential information, it is imperative for the patient to receive immediate care. This authority extends only to those services necessary to manage the crises and stabilize the patient. It is also limited to those situations where the patient is refusing necessary care on the grounds that he/she cannot afford it. For clarity in communication, we shall call this privilege the “Mission Privilege.”
E. Granting financial assistance is at the sole discretion of St. Vincent’s Health System.
F. Discount for Uninsured Patients with the Ability to Pay
Uninsured patients with the ability to pay will be provided a discount based on an individual hospital schedule determined as of July 1st each year. Patient Financial Services management will communicate the results at each facility.
IV. Patient Right of Appeal
The patient has the right to a fair, efficient and timely process for appealing decisions regarding the amount of financial assistance provided by St Vincent’s Health System. The patient has the right to appeal if their application is denied or if they feel the amount of financial assistance provided is incorrect.
If the patient wishes to file an appeal they must make the request in writing and provide the reason for the appeal within thirty (30) days from the time assistance is awarded. The appeal must include the patient’s full name, address, date of birth and social security number and the date services were rendered at St Vincent’s Health Systems.
The written appeal must be sent to:
St Vincent’s Health Systems CBO
Attn: Director-Patient Financial Services
50 Medical Park East Drive, Suite 300
Birmingham, AL 35235
The Director of the Central Business Office will forward the request for appeal to the V.P. of Finance and the facility Chief Operating Office for review. Based on their determination the patient will be contacted and explained the decision.