Financial Assistance Policy

ADMINISTRATIVE POLICY: Financial Assistance

POLICY NUMBER: 2003

Policy Statement:

Albany Memorial Hospital and Samaritan Hospital are committed to minimizing the financial barriers to health care that exist for certain members of our community, in particular, those not adequately covered by health insurance or governmental payment programs. As such, financial aid to assist low income, uninsured or underinsured individuals with their hospital claims is available to all who qualify.

Procedure:

Eligibility Criteria:
1. All hospital services provided (including services at our primary care sites) which are deemed to be medically necessary are eligible for consideration for Financial Aid.
Our Financial Aid program is in the form of a discount off of our commercial payment rates. Any open balance including co-pay and deductible balances are eligible to be considered for a discount.

How to Apply:
Applications and/or confidential assistance with completion of the application is available from any Registrar or from our Patient Accounting Office by calling 471-3603.

2. Prior to or when appropriate, subsequent to approval for financial aid Patients may be asked to apply for Medicaid or other publicly sponsored insurance programs. We have staff available to assist you in that process. Medicaid may require the patient to make a payment to the hospital as a condition for Medicaid approval. This is known as a spend down amount. Any payments the patient is required to make to the hospital including, but not limited to, the "spend down" amount and co-pay and/or deductible amounts are eligible for consideration in our financial aid program. Failure to apply or comply with the Medicaid application requirements will result in denial of Finance Assistance.

2a. If you have been awarded Financial Aid and during a subsequent hospital visit you incur charges greater than $5,000.00 you may be requested to apply for Medicaid. Failure to submit a completed NYS Medicaid application within 90 days of request will result in revocation of current financial aid status for all services provided after the date of cancellation notice.

3. Low income is defined as falling below 300% of the federal poverty guidelines. Guidelines are indicated on the attached chart A. Financial Aid award is based upon Family size and Family income. Homeless patients are automatically
considered to be eligible as are self pay patients admitted to any of our Behavioral Health programs.

4. Household income: This refers to income before deductions (taxes, social security insurance premiums, payroll deductions,) etc. Total Household Income is income from all members of a household from the following sources: wages, unemployment income,
Workers Compensation, Veterans benefits, Social Security Income, Disability Insurance, public assistance (Welfare), alimony, child support and other cash income.

5. We feel it is important that all patients pay some portion of the cost of their health care. For all patients a minimum monthly payment will be established at the time the payment plan is arranged. Payment plans will be reviewed periodically to ensure the account remains in good standing.

The extent of supporting documentation required in any particular case shall be determined by the Hospital, in its sole discretion; and may include copies of pay stubs, bank statements, tax returns, Medicaid rejections etc.

6. A completed Financial Assistance application must be received within 90 days of Discharge date. Applications deemed to be incomplete will be returned to the applicant with notification that failure to provide all required data either to the hospital or its agent within 30 days of receipt of the returned application will result in a denial for financial aid. Determination of need for Financial Assistance will be made based upon the information provided on the Financial Assistance application along with data obtained by Cardon Healthcare, a firm that assists the hospital in processing your application. We may also utilize internal criteria that may include review of previous account history and a credit check(s). The Hospital reserves the right to request additional information to support the application process.

7. A determination of whether a patient is qualified will be made within 45 days of receipt of a completed application. Recommendation for final approval will be made by the Supervisor for Patient Financial Services and the A.V.P. for Patient Financial Services for balances not exceeding $10,000. For balances greater than $10,000, recommendation for final approval will be made by the A.V.P. for Patient Financial Services to the Vice President/ CFO for the acute care division.

8. Patients who do not meet the low-income definition but who feel their hospital bills are excessive will be reviewed on a case-by-case basis.

9. A Financial counselor is available to arrange an affordable monthly payment plan.

Payment Plans:
1. For patients falling at or below the Federal Poverty Level a nominal payment as established by the NYS Commissioner of Health will be requested for each service date. For all other patients who qualify for a discount of up to 95% of commercial rates a minimum monthly payment may be established at the time the discount amount is determined.

2. We feel it is important that all patients pay some portion of the cost of their health care unless the patient can demonstrate extreme financial distress in which case a 100% discount is available. The A.V.P. for Patient Financial Services must approve all financial aid awards totaling 100% where the nominal payment requirement has been waived.

3. Payment plans will be reviewed periodically to ensure the account remains in good standing.

4. If the patient feels at any time that their payment arrangement has become a burden due to a change in their financial situation a meeting can be scheduled with a financial counselor.

5. This policy only covers services provided by the Hospital. This policy does not apply to other bills you may receive from private physicians who may be involved in your care including but not limited to: Radiologists, Pathologists, Anesthesiologists or Emergency Room Physicians.

6. Reductions to Hospital bills will be made as a discount percentage off of the expected reimbursement from our highest volume commercial payer for services provided as indicated on the attached chart A.

7. It is understood that this program has been developed solely by the Hospitals and the Hospitals reserves the right to amend or discontinue the Program at any time.

8. Credit Supervisor acute care division will approve all acute care applications. Director for the primary care network billing will have responsibility for PCN. In the event that the applicant is a relative or personal acquaintance of the respective individual who would be expected to review and approve the applicant that person will excuse themselves in favor of their counterpart. Once a decision is made that decision will be communicated to the A.V.P. for Patient Financial Services for final approval.

9. Documentation for each application will be stored in Patient Financial Services for two years and then stored off-site for the legally required storage requirement.

10. Applications are approved for a period of twelve months and are effective as of the first day of the month in which the services for which the application was submitted were provided.

11. Applicants who are denied financial assistance may reapply should there be a significant change in their financial situation. Examples include but are not limited to loss of job, catastrophic injury, etc.. The decision to accept a new application will be made on a case by case basis.

12. As an alternative option to those uninsured patients who choose not want to apply for Financial Aid the Hospital will also offer a 40% discount off of gross charges if account is paid in full within 30 days of the date of the Hospitals first patient statement.

13. Hospital Collection practices - it is the practice of our Hospitals to send 3 (three) patient statements requesting payment. One or more phone calls may also be made.

The first statement is mailed within 10 (ten) days of service date with subsequent statements sent approximately every 30 to 45 days. Our third patient statement is our final notice - if full payment or some other satisfactory payment plan is not in place within 14 days of that final notice the account is referred to our collection agency.

14. Service Area: What Services are Covered:
All Hospital services provided (including services at our primary care sites) which are deemed to be medically necessary and applies to patients residing within our defined primary service area.

Primary Service Area consists of the following counties:
Albany
Columbia
Greene
Rensselaer
Saratoga
Schenectady
Schoharie
Warren
Washington

If your county of residence is not listed above and you would like to apply for Financial Aid we encourage you to do so, no application will be refused due to location of residence.

Original Implementation Date: January 28, 1992
Last Review Date: 5/96, 3/99, 3/02, 2/04
Last Revision Date: 5/96, 3/99, 3/02, 2/04, 4/04, 10/06, 05/07, 11/08, 05/09, 06/09, 07/10,08/10, 10/12/2010, 12/10

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