Financial Assistance Program Summary
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.