III. Financial assistance eligibility criteria
1. If based on the information in the financial assistance application, the patient is determined to be eligible to receive financial assistance on the provider charges. For the purposes of this policy, “provider charges” means the full billed charge for all services provided by the provider, including professional services and other ancillary services.
2. The level of financial assistance will be based on the eligible patient’s classification as financially indigent, medically indigent, or uninsured patient, in accordance with the below. The discounts set forth below and elsewhere in this Policy applies solely to the Provider Charges and do not apply to patients liabilities such as co-pays, deductibles, and co-insurance.
A. Medically Indigent Patients.
a. “Medically Indigent” means a patient whose Total Yearly Income exceeds 200% of the Federal Poverty Guidelines, but whose medical bills after payment by all third parties exceed 5% of their Total Yearly Income and who is unable to pay the remaining bill. For the purposes of this Policy, the term “Total Yearly Income” means the sum of the total yearly gross income of the patient or the responsible party.
b. If a patient is determined to be Medically Indigent, then such patient may qualify for a 50% discount.
B. Financially Indigent Patients.
a. “Financially Indigent” means an uninsured or underinsured patient whose Total Yearly Income is less than or equal to 200% of the Federal Poverty Guidelines.
b. These patients are eligible for a 100% discount on the Provider Charges.
c. The criteria used to determine if a patient is classified as Financially Indigent is contained in Exhibit B of this Policy.
a. An “Uninsured Patient” means a patient who does not have any third party insurance. For the avoidance of doubt, a patient is not considered an Uninsured Patient if they have insurance, but the services they receive from Provider is not covered by their insurance.
b. It is the Provider’s policy to provide all Uninsured Patients based on the sliding scale outlined on Exhibit C.”
3. Financial Assistance Committee.
a. In certain situations, it may be appropriate to grant a patient financial assistance even though the patient’s financial situation does not satisfy the requirements set forth in Provider’s Financial Assistance Eligibility Criteria Guidelines.
b. In these situations, the Financial Assistance Application and other pertinent information may be reviewed by the Provider’s Financial Assistance Committee, who will make a determination as to the patient’s eligibility for financial assistance.