Charity Care Policy
In accordance with its mission to serve the poor and vulnerable, St. Mary’s Hospital & Regional Medical Center, operated by the SCL Health System, will not deny necessary medical services to patients because they do not have ability to pay for such services. St. Mary’s assists all patients in accessing available resources for payment of their services. When such resources are not available, patients are evaluated for financial assistance/charity care.
Charity care determinations are made according to approved policy and in a manner that reflects financial stewardship and social responsibility.
Charity care is granted based on a patient’s inability to pay for medical care. Charity care is not designed to assist those who are able but unwilling to pay. The patient’s willingness to discuss his/her account and disclose pertinent financial information is relied upon to make the distinction between inability and unwillingness to pay.
St. Mary’s Financial Assistance and Charity Care policy applies only to hospital services, services received in clinics owned by St. Mary’s, and services from providers employed by St. Mary’s. St. Mary’s cannot provide financial assistance for services provided by independent physicians (such as general surgeons, anesthesiologists and emergency medicine physicians) who provide services in St. Mary’s facilities as members of the hospital’s medical staff.
This policy assists patients in understanding the process and eligibility requirements for obtaining financial assistance for services they receive at St. Mary’s Hospital.
This policy also provides guidance to St. Mary’s registration staff, financial counselors, and/or customer account representatives in identifying and evaluating uninsured and underinsured patients who are unable to pay for hospital services for the purpose of granting financial assistance, including discounts and charity care, on the basis of income, assets, and all other financial resources.
St. Mary’s Charity Care Process in Brief
- Payment for services is discussed at registration/scheduling. Financial Assistance brochure is provided.
- Uninsured/underinsured patients are prescreened for possible financial assistance.
- Eligible patients are:
a. referred for government program assistance,
b. asked to complete an application for St. Mary’s financial assistance program.
- Application evaluated and charity care approved or denied.
Patient is prescreened for eligibility for financial assistance
Arrangements for payment for hospital services are discussed with each patient at registration/scheduling or, in the case of emergent services, following the delivery of service. This discussion includes coverage by private or government health plans or insurance programs and payment plans for non-covered expenses. Patients and/or their representative are informed verbally that financial assistance may be available if they are unable to pay part or all of the cost of their services. They are also provided a printed brochure, “Financial Assistance: Financial Counseling and Assistance with Your St. Mary’s Expenses.”
If it is determined the patient is uninsured or under-insured, a pre-screening process is performed using a prescreening questionnaire, available here. This prescreening could take place when the patient is scheduling a service, at the time of service, or during the billing and collections process.
If the patient qualifies for a government program
In the prescreening process, a registration specialist, scheduler, or financial counselor determines if the patient may be eligibility for financial assistance. If the patient meets the guidelines of a government program, such as Medicaid, Medicare, or disability coverage, the patient is referred to an independent vendor located in the hospital who assists in that application.
The application process continues
If the patient does not meet government program eligibility, the screening process continues to determine if the patient is eligible for a program administered by St. Mary’s. The patient is provided an application packet to complete and return to Financial Counseling within 10 days of being discharged from the hospital. Packet includes a postage-paid, return envelope. The patient is required to complete a financial statement and provide supporting documentation which could include some or all of the following, depending on the patient’s situation:
- Drivers license or state identification card
- Proof of immigration status
- Copies of last three months of paycheck stubs and other documentation of total household income
- Social Security card
- Social Security disability insurance (SDI) or Supplemental Security Income (SSI) award letter
- Proof of payments from pension plans
- Proof of payments from Aid to the Needy and Disabled (AND) or Old Age Pension (OAP)
- Medicare or health insurance card
- Previous year’s federal and state income tax returns including all attachments and documents filed with the return, such as W-2s, 1099, schedules, etc.
- Profit and loss statements covering previous 12 months if self-employed
- Documentation of monthly housing expenses (rent or mortgage payment)
- Statements from all current savings and checking accounts for previous two months
- Make, model and year of all vehicles, including autos, trucks, motorcycles, boats, motor homes, recreational vehicles, etc.
- Documentation of other income sources, including alimony, business ownership/partnership, rental properties, investments, financial settlements, annuities, etc.
- Medical, dental, and pharmacy expenses
- Legal documentation defining marital status or domestic situation, such as divorce or legal separation, issued and/or in force during the previous 12 months
- Investments in stocks/bonds, certificates of deposit (CD), individual retirement accounts (IRA), life insurance policies with cash or loan provisions,
Upon receipt of the completed application and required documentation, a financial counselor completes an objective evaluation to determine the patient’s financial ability to pay for their St. Mary’s medical expenses. The financial counselor uses a standardized analysis tool which requires input of the financial information provided and a number of other factors including:
- Household gross income
- Household expenses
- Household assets
- Employment status and earning capacity
- Housing situation
- Family size
- Amount and frequency of recurring health care services
- Other possible sources of payment for hospital services
If the patient qualifies for financial assistance
If the objective evaluation indicates the patient’s adjusted household income is less than or equal to 400 percent of the currently published Federal Poverty Income Guidelines, the patient will be offered some level of financial assistance. This assistance may consist of a percentage discount off the cost of hospital services, up to 100 percent off. Based on household income, a sliding scale is used to determine the level of discount. Assistance may be through the Colorado Indigent Care Program (CICP) or St. Mary’s Charity Care program.
Colorado Indigent Care Program (CICP)
CICP is a state funding program in which St. Mary’s participates. For information about CICP, visit this website: http://www.colorado.gov/cs/Satellite/HCPF/HCPF/1214299805914.
Financial assistance from St. Mary’s Charity Care program
If the patient qualifies for financial assistance but does not meet the requirements of CICP, they will be offered assistance under St. Mary’s Charity Care program.
If assistance is approved:
- The patient or their representative will be notified to come to the hospital Financial Counseling office to sign the necessary documents.
- The sliding scale discount rate will be retro active to cover St. Mary’s services for the previous six months and potentially up to six months from the date of approval.
- If patient owes an out-of-pocket amount, payment will be requested or financing options offered.
- Account balances from $0.01 to $24 will be the patient’s responsibility and no sliding scale adjustment will be made.
- For patients approved for charity sliding scale and receiving recurring services, such as dialysis; oncology treatment; physical, occupational or speech therapy; coagulation management; cardiology or lab services, the sliding scale will be effective for six months from the date of the first service in the course of treatment. These patients will pay an out-of-pocket maximum of 20 percent of their adjusted gross annual income, and this maximum amount will be assessed per calendar year per recurring diagnosis or service type. Patients are responsible for monitoring and documenting their out-out-of-pocket expenses and informing St. Mary’s when the maximum limit is met.
- Fixed income and/or terminally ill patients will be reviewed annually for charity assistance eligibility.
- Patients receiving assistance through St. Mary’s Charity Car program with a household income at or below 40 percent the Federal Poverty Level will receive 100 percent of charity adjustment on their bills. The patient must provide updated financial information every 90 days if they continue receiving services.
If financial assistance/charity care is denied
If the financial counselor’s objective analysis indicates the patient does not qualify for financial assistance/charity care because he/she has the financial ability to pay (i.e., household income is in excess of 400 percent of Federal Poverty Income Guidelines), the patient or their representative will be informed of this decision by phone and mail.
If financial assistance is denied, the patient may be eligible to arrange a payment plan, or receive a prompt pay discount or short-term financing. A financial counselor can assist with these arrangements.
Additional considerations for denial of financial assistance/charity care
In addition to failure to meet program financial requirements, applications for charity care may be denied if:
- The application is incomplete and the patient/representative fails to provide sufficient information or documentation to complete the application following requests from Financial Counseling.
- The applicant has savings, cash investments or other assets in an amount sufficient to cover all or a portion of the account balance without placing financial hardship on the family.
- Publicly available records indicate the applicant has sufficient credit available to obtain a loan to repay the account and sufficient means to repay the loan without placing financial hardship on the family.
- The applicant has disposable income which is being spent on nonessential items or services.
- The applicant refuses to supply or falsifies requested information or documentation.
- Charity care is sought to pay for cosmetic surgeries, elective services, or procedures which do not meet criteria as medically necessary as determined by the patient’s physician.
Appealing a decision
The patient may appeal the denial decision in writing within 15 days of St. Mary’s communicating the decision. St. Mary’s is not required to conduct an appeal initiated more than 15 days after the decision was communicated. The patient/representative may request the denial decision be reconsidered based on one of the following reasons.
- The initial decision was based on inaccurate information or miscalculations because the patient/representative was uninformed.
- Miscommunication between the patient and the financial counselor caused incomplete or inaccurate data to be recorded on the application.
- Hardship circumstances, financial or otherwise, not revealed by a financial statement prevent the patient from making payment.
As a first step in the appeal/review process, a designated St. Mary’s manager reviews the application materials submitted and the evaluation completed by the financial counselor for accuracy and incorporates any new or corrected financial information submitted by the patient/representative.
- If the manager finds the initial evaluation was not completed accurately, he/she will correct the application.
- If the correction and/or additions of new data results in reversal of the denial of charity care, the patient will be informed of the new decision as outlined above and, the charity care status will be retroactive to the initial date of application.
The manager will request a higher-level review by a committee of hospital leadership if:
- The initial application is found to be accurate or additions/corrections to the application do not change the decision to deny charity care; or
- The patient has submitted information explaining a hardship situation that prevents them from making payment.
The committee will then make the final determination on eligibility for financial assistance and/or charity care and the patient will be informed of the decision within 15 days of the receipt of the appeal request from the patient.