National Jewish Health Financial Assistance Policy - Administration of Financial Assistance

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Policy

National Jewish Health believes in providing access to care for all patients, including those of limited means. No patient will be denied admission to or outpatient treatment from National Jewish Health on the basis of race, color, religion, national origin, sex, sexual orientation, disability, age, or ability to pay. National Jewish Health retains the right in its sole discretion to determine a patient’s ability to pay.

National Jewish Health will participate in the Colorado Indigent Care Program (CICP) and Colorado Medicaid programs.

National Jewish Health will also offer its own financial assistance program (NJFAP).

 

Purpose

This policy serves to establish and ensure a fair and consistent method for the review and completion of requests for charitable medical care to our patients in need.

 

Scope

NJFAP is available to all patients for the following:

  • All medically necessary services provided by National Jewish Health and are ordered by National Jewish Health Physicians.
  • Prescriptions ordered by National Jewish Health Physicians and filled at the National Jewish Health Pharmacy.

 

Policy Statements

It is the policy of National Jewish Health to offer financial assistance to patients, who are unable to pay their hospital and/or clinic bills, due to difficult financial situations. A National Jewish Health Financial Representative will review individual cases and make a determination of financial assistance.

National Jewish Health determines the need for charity care by reviewing the particular services requested or received, insurance coverage or other sources of payment, a person’s historical financial profile and current financial situation. This method allows for a fair and accurate way to assist patients who are experiencing financial hardship. Partial and/or full charity care will be granted based on the individual’s ability to pay the bill.

Eligible individuals include patients who do not have insurance and patients who have insurance but are underinsured. Patients must cooperate with any insurance claim submission and exhaust their insurance or potential insurance coverage before becoming eligible for financial assistance.

 

Other factors affecting eligibility are as follows:

  • Income – Assuming that other financial resources are not identified as viable funding sources, the Federal Poverty Income Guidelines will be used in determining the amount of write-off. The Poverty Guidelines are updated annually each January.
    • Minimum criteria for partial write-offs will be to grant patients earning between 250 and 400 percent of the Federal Poverty Income Guidelines some level of discount depending on the circumstances in each case, but averaging a 50 percent discount for all patients in this income level.
  • Evaluation of the patient’s savings, checking, investment assets, and overall financial position.
  • Assessment of the patient’s real property assets.
  • Evaluation of the patient’s monthly expenses, including living expenses, medical expenses, and other expenses.
  • Nature of the medical condition or care required – consideration of services unique to National Jewish Health vs. potential of local facilities providing care.
    • Any special circumstances that the patient would like National Jewish Health to consider.
    • Eligibility is contingent upon patient cooperation with the application process, including Medicaid or Medical Assistance application completion where applicable, and submission of all information that National Jewish Health deems necessary in order to determine the level of any financial assistance that may be considered.
    • Priority is given to requests for care of local and regional patients, and to care that is unique to National Jewish Health.

Limitations

  • Services provided by non-National Jewish Health care providers.
  • Ancillary services that are ordered by a non National Jewish Health care provider. (Unless these are services that result from prior services with a National Jewish physician.)
  • Insurance co-payments due for physician services.
  • Insurance co-payments required by Medicaid, CICP, or other need based programs.
  • Patient convenience items.
  • Patient meals and lodging.
  • NJFAP will not be available to patients who exceed 400% of the Federal Poverty level unless their balances exceed $500.00 for local patients or $2,000.00 for out of state patients.

National Jewish Health Financial Assistance Procedure

National Jewish financial counselors will evaluate patients who request their services for financial assistance programs. Financial counselors will first determine the patient’s eligibility for Medicaid, CICP, CHP+ or Part D financial assistance programs. Non-Colorado applicants applying for the NJFAP as primary must provide proof of Medicaid denial from his/her home state, if relevant. In the event that there is a financial need but the patient does not qualify for other assistance, the financial counselors will determine if the patient qualifies for NJFAP.
The initial eligibility period for both NJFAP and CICP is 12 months. Each patient will have to re-apply at the end of each the 12 month period in order to continue in either program. If there is a change in financial circumstances during the initial or subsequent twelve month period(s), such as income or family status, an updated or new application must be completed. Applicants are required to inform the National Jewish Health Financial Counseling Office within 30 days upon any change in income or family status.
Patients will receive written notification when application is approved, denied, or pended, for additional documentation. Applications may be denied for ‘Failure to provide documentation’ if the applicant does not provide all required documentation to the National Jewish Patient Finance office within 30 days from initial application date.

Reasons for Denial

  • Sufficient income or sufficient asset level.
  • Patient is uncooperative or unresponsive despite reasonable efforts to work with the patient.
  • Patients who refuse to provide requested documentation or provide incomplete information, or who refuse to be screened for other assistance programs before screening for NJFAP.
  • Patients who fail to pay co-payments as required by the assistance program or those who fail to keep current arrangements or to make appropriate arrangements on past payment obligations with National Jewish.
  • Patients who failed to resolve an outstanding obligation, which was deemed to be bad debt in the past 12 months.

Guidelines

  1. Patients who have primary insurance coverage through an HMO, PPO, Workers compensation, Medicaid, or other insurance plans that deny access to our facility are not eligible for CICP or NJFAP. A plan is considered to deny access if they refuse to authorize the patient to come to National Jewish or if the coverage is too restricted to be clinically effective (i.e. insurance only covers physician visits). Patients whose insurance deny them access to National Jewish Health and still wish to come to National Jewish Health are eligible for a thirty percent (30%) discount.
  2. Patients who have access to other medical care (e.g., primary and secondary insurance coverage or a required service provider, also known as a carve out) must first utilize and exhaust their insurance benefits. CICP or NJFAP is available to assist these patients with co-insurance, deductibles, and co-payments (except for co-insurance, deductibles, and co-payments required by Medicaid, CICP, or other need based programs or co-pays resulting from a physician service) for services received and ordered by a National Jewish Health provider at National Jewish Health. Generally, neither CICP nor NJFAP is not available to cover services that are denied by a patient’s insurance company; however, exceptions may be made on a case-by-case basis considering medical and programmatic implications as mentioned in Section I above. Exceptions must be approved by the Director or Manager of Patient Financial Services.
  3. All applications for financial assistance are to be completed, received, and evaluated prior to the prospective patient’s scheduled appointment or admission. Patients may apply retroactively for services up to 90 days from the date the balance was turned to self pay. Exceptions to the 90 days time filing rule may be taken into consideration and must be reviewed and approved by the Patient Financial Services Director or Manager.
  4. Financial assistance determinations are valid for a twelve month period. In order to continue in the program, each patient will have to reapply and be reapproved.
  5. NJFAP will not cover coinsurance, co-payments, or deductibles for patients who have insurance, including Medicare, with no secondary coverage, if the patients are eligible for secondary coverage from Colorado Medicaid, CICP or Part D financial assistance.
  6. Unemployed applicants who have been unemployed for more than twelve (12) months and who have no custodial dependents under the age of 12 must provide proof of disability, as evidenced by a physician’s certification, prior to qualifying for the NJFAP plan. Exceptions to this rule may be granted pursuant to section XI below.
  7. Applications for individuals 18 and under who are not U.S. citizens or are not documented legal immigrants of the U.S. or its territories will be eligible to apply for the NJFAP. Although they will require management approval. National Jewish reserves the right to adjust qualification criteria to consider the unique circumstances surrounding foreign applications. Patients 19 and older are not eligible to apply.
  8. Patients who falsify the financial assistance application or withhold any information pertaining to the application requirements will no longer be eligible for the program and will be held responsible for all charges incurred while enrolled in the program retroactively to the first day that charges were incurred under the program.
  9. Patients must inform the National Jewish within 30 days of any changes in income, assets, expenses, family status, or change in insurance coverage or plans.
  10. Payments of medical bills made within the previous 12 months rolling period from initial approval date, may be considered as a deduction for NJFAP. Documentation by cancelled checks, EOB’s, or a copy of a current payment contract must be obtained.
  11. Occasionally, a patient’s financial circumstances may require the NJFAP, even though the patient would not normally qualify. An example might be an applicant who is over the maximum poverty level allowed, but may have incurred very high medical costs recently. Exceptions like these should be extremely rare and must be approved in advance by the Patient Financial Services Director or Manager.
  12. Patients who have received medical services at another facility, that were provided by NJH physicians, and who are in need of financial assistance, may be eligible for a discount up to 40%. Patients must send other facilities’ letter of financial assistance approval in order for discount to be applied.

Method of Applying for Financial Assistance

Patients who want to apply for financial assistance or who have been identified as a potential charity care recipient will be informed of the application process either before receiving services or after the billing and collection process has begun. The application process may be waived or suspended due to medical necessity, including timing and urgency of care. Patients or their representative can obtain a charity care application at no charge by contacting Patient Financial Counseling Office at 303.398.1065, or downloading and printing the application form.
All patient/guarantors who receive a financial assistance application must complete and return the application at least ten (10) working days prior to your scheduled appointment (unless the patient calls with a legitimate reason to extend the deadline).

The following documents must also be received to process the application:

  • Copies of ID’s and /or birth certificates for all family/household members
  • Most recently filed income tax return. –Including all self employment tax forms
  • Most recent 3 months of complete bank statements.
  • Health insurance cards including Medicare and Medicaid.
  • Most recently 3 months of earnings history if applicable (check stubs, letter from employer on company letterhead)
  • Your most current month’s complete bank statements for checking & savings account and/or Certificate of Deposit/ Money Market accounts.
  • Proof of three full months of self employment deposits and expenses w/receipts (business ledger)
  • Most recent 3 months of self-employment bank statements- Complete statements, all pages
  • Proof of unearned income if applicable. (unemployment, social security, payments from retirement plans, etc.)
  • Proof of Vehicle Equity Information: make, model, and year, mileage, amount owed (copy of loan agreement or last payment stub showing balance due)
  • Proof of Vehicle Registration for current year.
  • Proof of Real Estate Information on 2nd home or other property -county tax statement on value of home.
  • Proof of Business Equity Information.
  • Proof of any medical deductions paid one year back by receipts: Prescriptions paid for one year past (pharmacy print out) ; Receipts of any medical expenses paid, dental expenses, vision care expenses, medical equipment which includes oxygen.
  • If there is no income in the household, please provide one month of current living expenses. Call 303.398.1065 for list of these expenses.

A Financial Counseling Representative will review all returned Financial Statements to determine if they are complete. The Financial Counseling Representative will consult the Financial Assistance authorization guidelines for consideration. Once a decision has been made, a letter is sent to the applicant advising them of the decision.

Confidentiality

National Jewish Health staff will uphold the confidentiality and individual dignity of each patient. National Jewish Health will meet all HIPAA requirements for handling personal health information.

 

Approved by National Jewish Health Board of Directors.

 
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