Financial Assistance Policy
Purpose / Statement: Bayhealth Medical Center is committed to providing Health Care Services to patients in the Kent and Sussex counties and surrounding areas regardless of their ability to pay. The Financial Assistance program was established to provide financial relief to those who are unable to meet their obligation to Bayhealth Medical Center, regardless of age, gender, race, social or immigration status, sexual orientation or religious affiliation.
1.1. Financial assistance applies to charges for traditional, non-elective hospital services to patients that meet the financial criteria set by the Medical Center using the Federal Poverty Income Guidelines. The uncompensated care schedule will change whenever the Federal Poverty Income Guidelines are changed which is normally annually. If services are not emergency related, but medically necessary, the Medical Center can seek input from the Physician and/or Utilization Management Director in determining urgency of the services rendered.
1.2. Charity Care: Uninsured and underinsured patients are eligible to participate in the Medical Center’s charity care program based on their total family income. Patients are prescreened prior to starting the application process and may be deemed ineligible if the patient is eligible for Medicaid or other third party reimbursement or refuses to complete the application process. Charity approvals qualify the patient for a 100% discount on patient responsibility balances. Applications received greater than 90 days from discharge may only be eligible for an 80% discount. Approvals are effective 6 months from the application receipt date. Patients would need to reapply after the 6 month period.
A patient’s eligibility is determined by proof of income, family size and assets. Effective July 1, 2014 Bayhealth has a presumptive charity care program whereby all uninsured patients will be screened for financial assistance. Patients/Guarantors meeting the pre-defined criteria will have their balance for that episode of care only, approved as charity. Patients not meeting the presumptive charity criteria are eligible to apply for financial assistance through the application process.
Bayhealth requires the following documents to support income: tax return for the most recent year, pay stubs from all sources, bank statements from savings, checking, and investment accounts. Additional information may be required as identified on the application based on an individual’s circumstances. Bayhealth Medical Center reserves the right to check the veracity of the information at their discretion.
Patients may appeal their non-approval decision. To be considered for an appeal, patients must submit a written letter requesting the appeal and supporting their hardship. Additional documentation may be required to support the hardship.
Delaware’s Adult Poverty Medicaid program does not provide retroactive coverage to the individual’s application date rather; qualified individuals are eligible from the approval date forward. Effective July 1, 2013, patient balances incurred between Bayhealth’s Medicaid eligibility vendor application submission date and approval date for Delaware Medicaid will be deemed as charity upon Medicaid’s approval determination.
Migrant workers and the Homeless often cannot be reached to complete the Charity application process. Once we confirm the customer is a migrant worker or homeless, the account will be written off as uncompensated care. Documentation to confirm migrant worker status is a letter from the farm documenting the hourly wage, frequency of payment and length of employment.
To comply with the EMTALA regulation, Bayhealth treats all emergency room patients regardless of their ability to pay. Medicaid eligible patients who seek care in our Emergency Department that is determined by Medicaid to be a non-emergent health condition can apply for financial assistance to see if their non-covered balances can be deemed as charity.
1.3. Federally Qualified Health Centers: Bayhealth does not participate in the CHAPS program but is committed to serving the Community and will honor the Federally Qualified Health Center’s approval for diagnostic services only. Patients will be required to apply for financial assistance through Bayhealth for surgical, infusion or other invasive services. Proof, in the form of a card or letter, of the Health Center’s financial assistance approval is required.
To support this decision, Federally Qualified Health Centers are required to submit a copy of their financial assistance policy, application and example redacted approvals to support their determination. Bayhealth will maintain this information on file and the Federally Qualified Health Center should provide new copies annually.
1.4. Uninsured Discount Policy: Uninsured patients receive a discount of 12% of billed charges. Refer to the Uninsured Discount Policy, B9045.50, for application. Patients who qualify for charity will receive a charity allowance in lieu of a self-pay discount.
1.5. Payment Plans: Payment plans can be extended on Bayhealth’s Payment Plan schedule. Exceptions may be granted based on an individual’s financial situation for patients not meeting Bayhealth’s payment plan guidelines. Payment plan accounts go into default once the payment is 15 days past due thereby canceling the agreement.
1.6. Emergency Services: Emergency services will be provided to all patients regardless of their ability to pay. See Emergency Medical Treatment and Active Labor Act (EMTALA) policy, B9000.57 for further information on emergency care related services.
1.7. Volunteer Ambulatory Surgical Assistance Program (VASAP). The Medical Center also participates in the VASAP program. This program is for minor elective surgical cases. Eligibility will be based on income levels at the poverty level, family size, and cash assets. Applicants are referred to the Medical Center by physicians that will perform the surgical cases at no charge based on our determination of eligibility.
1.8. Exclusions: Contracted physician groups/providers, unless otherwise stated in this policy, are not obligated to honor Bayhealth’s Financial Assistance approvals. Patients should contact the individual physician group regarding their financial assistance policy/programs.
2. Areas Involved:
2.1. Hospital Administration
2.2. Patient Financial Services
2.3. Financial Counseling
3. Forms Involved
5.1. Policy Communication Methods
5.1.1. Policy is available on Bayhealth’s website.
5.1.2. Patient Access refers patients to a Financial Counselor if the patient is uninsured or expresses concern over the cost of services.
5.1.3. All clinical departments performing registration have the Guide to Bayhealth Billing pamphlet that provides information on the financial assistance policy and how to apply for assistance.
5.1.4. We attempt to contact self-pay/balance after insurance patients via the telephone, certified mail as appropriate, prior to placing the account in Bad Debt. If the patient indicates they are unable to pay, we advise them of our policy and screen them for financial assistance.