Do You Offer Financial Assistance?

Purpose: To establish policy and related procedures for financial assistance for patients who are unable to pay in full for their health care services and who meet the eligibility criteria set forth in this policy.

POLICY - 7/14/2020:

  1. Review the account to determine that no additional 3rd party liability coverage exists to pay on the account, including TennCare. This policy applies to patients who are not insured through a 3rd party or who are unable to pay balances in full after exhaustion of all 3rd party liability.
  2. Interview patients and/or guarantors to determine that all other means of account resolution have been exhausted.  Any income should be considered whether from active or passive activities, such as rental, social security, disability, retirement, alimony, child support, unemployment benefits, inheritance, investment or annuity payouts, gifts or fund raisers.  It also includes proceeds from life insurance, 3rd party settlements, or lump sum annuity payments.
  3. This policy applies only to the individuals who cooperate fully with the request for information needed to verify the patient’s eligibility, including appropriate identification.  Patients should respond in a timely manner and fully cooperate in applying for Medicaid or coverage by other government programs if required.
  4. Eligible Service Areas include the following Upper Cumberland counties: Putnam, Jackson, White, Cumberland, Warren, Van Buren, Cannon, Fentress, Overton, Pickett, Smith, Clay, Dekalb and Macon. CRMC and/or CRMG reserve the right to add/subtract from the list of counties in the service area.
  5. Provide patient/guarantor with a financial statement form and explain that they patient may be eligible for financial assistance if certain criteria are met. Mail the patient financial assistance letter, enclose an application and checklist of things needed.
  6. Documentation must include the completed application, all supporting material and a print out of the financial analysis work sheet. In evaluating a patient’s needs for financial assistance, CRMC/CRMG personnel may review the patient/guarantor’s W-2, tax return, pay-stubs, bank statements, written verification of wage from employer, written verification of public welfare agency, government agency, or other information attesting to the patient’s income status. Patients must provide information related to possible 3rd party liability incidents where applicable, including accident reports and copies of vehicle insurance policies.
  7. All expenses should be listed so they may be taken into consideration when the application is going through the approval process.  All members within the household need to be listed as well as proof of their income.
  8. All applications are to be sent to the CBO Supervisor for approval.
    • 0-$50     Approval by CBO Supervisor
    • $51 - $499     Approval by CBO Director, Management Operations
    • >$500     Approval by CRMC Chief Financial Officer
  9. Discounts will be based on income guidelines established by CRMC/CRMG up to 300% of poverty level. Income guidelines are based on the most current Federal Poverty Guidelines from the U.S. Department of Health and Human Services. A sliding scale of income based on family income will be used to determine the percentage of charity as follows:
    • 100% or below Federal Poverty Level     100% Discount
    • 100-150% of Federal Poverty Level     75% Discount
    • 150-200% of Federal Poverty Level     50% Discount
    • 200-300% of Federal Poverty Level     25% Discount
  10. Remaining Balances may be set up on a payment plan; however if any balances not paid get transferred to a collections agency.
  11. Other Factors to Consider
    • Finances
    • Expenses
    • Outstanding medical bills
  12. Patients that are not disabled, do not have minor children in the home, and are not working may be disallowed for assistance.
  13. Uninsured patients who do not qualify for financial assistance or who do not wish to apply may be offered a discount following the Patient Discount Policy.
  14. Re-evaluation must take place every 6 months to continue financial assistance.  If patient qualifies due to government assistance qualification, the financial assistance will coincide with that approval period.
  15. Financial Assistance Discounts will be applied to CRMG accounts as follows:
    • All dates of service prior to the award date that has not been paid, are not out to insurance, and have not been sent to collections.
    • All dates of service for 6 months after the award date unless the patient’s financial condition improves.
  16. If a patient is awarded financial assistance and patient payments have already been applied to the account, apply the discount to the remaining balance. Patients will not be refunded monies already paid.
  17. CRMC/CRMG reserves the right to grant financial assistance in extraordinary circumstances to patients who may not normally qualify for financial assistance. Also, we reserve the right to deny any patient who does not fully cooperate with our efforts to verify eligibility, provides false information, refuses to apply to government programs or Medicaid, or who fails to respond in a timely manner to requests.