Loretto Hospital Charity Care

Loretto Hospital Charity Care-Financial Assistance

Policy

Loretto Hospital provides quality health care and health related services that effectively and efficiently meet the needs of individuals, families and communities

Policy

Consistent with Loretto Hospital’s values of compassion and stewardship; It is the policy of Loretto Hospital to provide charity care to patients in need. This policy identifies circumstances under which Loretto Hospital will extend free of charge, or at a reduced amount, to an individual who is willing to pay for health care services, but whose financial status makes it impossible or impractical to pay fully for the services. The necessity for health care services will be based upon clinical judgment without regard to the financial status of the individual. Given the sensitive nature of these requests, all communications with the patient or family members will be handled in strict confidence and in a compassionate manner.

Definition of Terms

Charity Care: Health care services that Loretto Hospital agrees to provide free of charge, or at a reduced amount, to individuals who meet financial eligibility criteria.

Process

1. A request for financial assistance can be initiated by the patient, family member; patient’s attending physician, Patient Financial Service staff member or other health care department staff member, prior to, at the time services are rendered or as soon thereafter as possible.

As part of the insurance verification process, potential candidates for charity care will be identified by the Patient Financial Services staff. Additional candidates may be identified later in the account process through discussions with patients regarding their self pay obligations.

2. To ensure that charity allowances are granted for legitimate purposes, charity applications are submitted to the Patient Financial Services Department. Completed applications are initially reviewed and evaluated by the Patient Financial Services Director. Considering the patient’s individual circumstances and utilizing financial criteria and approved write off limits, the Director can either approve the request or recommend an appropriate amount of charity write off.

3. Recommended write offs beyond the Directors approval limit are submitted to the Chief Financial Officer for final approval of the charity amount.

Evaluation Guidelines

The amount of charity care approved will be based on financial eligibility criteria including, but not limited to current and anticipated future family income, assets, and expenses (including health care expenses), extenuating financial circumstances and availability of third party health care benefits. Specific criteria and formulas will be used as guidelines to determine charity adjustments; will be established annually for Loretto Hospital and may change with community, government and market influence. These formulas are maintained and updated annually by the Patient Financial Services department and are approved by the Chief Financial Officer.
The amount of charity care will be determined once all third party payments have been received.
If the Financial Services Department feels that the patient or family members qualify for assistance thru a State or Government funded program, an application will be submitted and charity care application will be processed pending the outcome of the assistance application. The patient or family members must co-operate with the application process for assistance to qualify for charity care.
The amount of charity care will be determined once all third party payments have been received.

Procedure

The Financial Assistance Program is administered by the Patient Financial Services department. The staff of the Patient Financial services department, in their patient account billing and collection responsibilities, have a unique opportunity as hospital representatives to identify potential candidates for financial assistance. Patient Financial Services staff may identify candidates at any time throughout the account process, such as: during insurance verification, IDPA Medical Assistance Application, post insurance payment and self pay collections. Due to the sensitive nature of these request, all communications with the patient of family member/representative will be handled in strict confidence and in a compassionate manner.

Requests for financial assistance may be initiated by any of the following individuals and at any point during the cycle of the patient’s account.

1. Patient/guarantor.

2. A representative for the patient/guarantor.

3. A hospital representative on behalf of the patient/applicant.

4. Patient’s attending physician.

The Loretto Hospital application for financial assistance must be completed and signed by the patient/guarantor/representative. The Hospital’s Financial Services staff will assist the applicant in the process. Applications are considered complete when all the necessary documentation is provided. Applications without sufficient documentation will be pended until the required documentation is received or denied if not received after reasonable attempts have been made.

If the patient is deceased and a responsible party is not identified, a hospital representative may generate the request and complete the application using available information and documents (e.g., IDPA spend down form, estate document, etc.)

Family income is defined as those earnings which are reportable to the federal government. Income documentation is defined as one or more of the following and must be provided prior to the adjudication of the application:

Prior year’s income tax return
Most recent W-2 form
Paycheck stubs or employer statement documenting wages for three or more months prior to the application for assistance.
If no documentation is available, a signed statement which testifies to the patient’s financial status may be provided by the person(s) providing financial support to the patient.
IPDA eligibility documentation
Print out from the Credit Bureau

The amount of financial assistance approved will be determined using guidelines which include, but are not limited to income, assets and expenses. Annual family income is evaluated using the Financial Assistance Program guidelines, and will be adjusted based on family size, health care expenses and other extenuating circumstances. Current and anticipated assets and expenses will be considered during the evaluation process.

Patients that are currently covered under General Assistance with Illinois Department of Public Aid are considered as eligible for Financial Assistance. Patients have already proven financial verification to Public Aid and are receiving only food stamps and $100.00 per month in cash.

Completed and approved applications are maintained along with a monthly printout indicating accounts written off for the month. The Financial Services staff submits the Charity Documents application with attachments to the Patient Financial Services Director for review.

The Patient Financial Services Director will evaluate the request and makes a recommendation based on the patient’s circumstances and the current Financial Assistance Program guidelines.

Charity Care Application Document