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Patients & Visitors > Financial Assistance Program Summary

Financial Assistance Program Summary

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Uninsured 100% Financial Assistance

Patient responsible for 0% of Medicare payment amount

  • Requires MA application and/or MA denial.
  • Requires Patient Financial Statement and proof of income.
  • Catastrophic medical event
  • Approval based on income less than 200% of Federal Poverty Guidelines (FPG), assets and financial need.

Note: If patient is uninsured and refuses to apply for MA the total patient income will be assumed to be a minimum of 201% of FPG regardless of actual income.

Uninsured Financial Assistance

Patient responsibility for 25% - 100% of Medicare payment amount

  • Patient is uninsured and income is greater than 200% of Federal Poverty Guidelines (FPG).
  • Requires Patient Financial Statement and proof of income.
  • Approval and amount of assistance determined by income, assets and financial need.
  • Catastrophic event
  • No other discounts or reductions are applicable.

Underinsured 100% Financial Assistance

Patient responsible for 0% of Medicare payment amount

  • Patient is insured and income is less than 200% Federal Poverty Guidelines (FPG).
  • Requires Patient Financial Statement and proof of income.
  • Catastrophic event
  • Approval based on income less than 200% of Federal Poverty Guidelines (FPG), assets and financial need.
  • Patient will not pay more than an uninsured patient.
  • No other discounts or reductions will applicable toward the patient residual amount.

Underinsured Financial Assistance

Patient responsible for 25% - 100% of Medicare payment amount

  • Patient is insured and income is greater than 200% Federal Poverty Guidelines (FPG).
  • Requires Patient Financial Statement and proof of income return.
  • Approval and amount of assistance determined by income, assets and financial need.
  • Catastrophic event
  • Patient will not pay more than an uninsured patient.
  • No other discounts or reductions will applicable toward the patient residual amount.

Notes:

If patient is uninsured and refuses to complete Patient Financial Statement, income will be assumed to be a minimum of 401% of Federal Poverty Guidelines(FPG) regardless of actual income and will be eligible for 25% Financial Assistance discount.

If patient is insured and refuses to complete Patient Financial Statement, income will be assumed to be a minimum of 401% of Federal Poverty Guidelines regardless of actual income.

 
 





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