Financial Assistance Guidelines
Community Medical Center
Financial Assistance Guidelines (FA)
CMC is a non-profit hospital offering a broad range of services, which are provided for patient’s medical and financial needs. CMC will identify FA based upon financial needs. It is our policy to offer FA to persons in need as early as we can identify those persons. FA is available without regard to race, color, creed, national origin, age disability, health care condition or marital status.
Statement of Principles:
- Treat all patients equitable, with dignity, with respect and compassion.
- Serve the emergency health care needs of everyone, regardless of ability to pay for care.
- Assist patients who cannot pay for part or all of the care they receive.
- Balance needed FA for some patients with broader fiscal responsibilities in order to keep or hospital’s doors open for all who may need care in our community.
The following will be used to determine if you qualify:
- Patient care, which is not medically necessary. This includes elective, cosmetic, or other care not reimbursable by insurance carriers and governmental payers. This will not be considered eligible for FA.
- Minor children/divorced parents. Both parents/legal guardians are responsible parties. Information about both parents will be required to complete the forms for FA.
- FA provided by CMC under this policy is secondary to all other third parties and resources available to the patient. If needed, assistance is available to help with an application for other sources of payment (Medicaid, Crime Victims, SSI, SSDI, etc.).
- Federal Poverty guidelines will be used to determine eligibility. These amounts will be updated as published in the Federal Register.
- The guidelines include help for persons below 200% of the FPL. A sliding scale is used for those falling below 300% but greater than 200%. Assets more than $7500 may be looked at when deciding the level of FA to be applied.
The chance for FA will be relayed to patients through the following methods:
- Pre-Service – During the pre-registration process for scheduled inpatients and high-dollar outpatient cases, the pre-reg staff will tell patient about the policy.
- Point-of-Service – At the time of service, self pay patients will be told about FA and will be offered the forms. Help is available for patients completing the forms.
- Post-Service – A message is printed on patient billing statements to notify patients that FA is available. Patient Accounts staff will notify self pay patients of the FA program through the customer service.
The following proof of income must be included with the FA Application:
- Payroll check stubs, or other monthly income sources for the last three months for all persons in the household.
- Notice of filing from Medicaid, state medical Crime Victims, etc.
- Copy of latest Federal Income Tax Return, with schedules.
Annual income will be calculated using income documents. This is the gross annual income. Total income of the last 3 months pay stubs will be multiplied x 4 to arrive at a yearly income.
The patient’s status will be looked at using the Patient Assistance Eligibility Guidelines table.
Patients who have large medical expenses compared to their means could be eligible for more reductions. This will be done on an individual basis.
If CMC determines that any documentation or information is untrue, the application will be denied.
Payment arrangements will be made for the balance according to our credit policy.
The President of CMC can make exceptions to this policy.
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