PolicyStat ID:1794696
Original:
12/1992
Review:
09/2015
Next Review:
09/2018
Policy Champion: Director of Patient
Financial Services
Policy Area:
SJ Healthcare Administrative -Financial
Service
Applicability:
St. Joseph Hospital
Free Care, MG-02
PURPOSE:
In keeping with the Mission of St. Joseph Healthcare, which promotes health and well-being for all people, and in
the spirit of responsible stewardship, the following policy for free care is to assure that those persons with limited
finances, who meet the specified criteria, will receive health care services at no charge or at reduced charges.
SCOPE:
St. Joseph Healthcare.
Standards:
1. St. Joseph Healthcare will make free care available to our patients in need when the family’s income is within
the guidelines and all other means of reimbursement have been exhausted. All patients who wish to apply
for Free Care should be referred to the Patient Accounts Department for instructions of how to qualify. Full
disclosure of all personal resources is required so that determination can be made as to the applicant’s
eligibility for this type of allowance.
2. All applicants are to be counseled as to the availability and eligibility for funds from other state or federal
agencies such as Medicare, Medicaid, SSI, Veterans Benefits, etc., to insure that all other sources of
reimbursement have been exhausted prior to the granting of Free Care.
3. Free care consideration may be available only when a patient resides within the St. Joseph Healthcare
primary or secondary service area as defined in Attachment #1 of this policy.
4. The availability of free care will be consistent with the entity’s ability to provide such Free Care and should
not exceed the amount approved by the St. Joseph Healthcare Board of Directors.
5. Free Care should be granted only when services are medically necessary. Non-medically necessary
services should be defined as cosmetic or patient convenience services.
6. A family’s income level must fall within the entity’s guidelines approved by the governing board. The
guidelines to be used are the current CSA Income Poverty Guidelines for all states, except Alaska and
Hawaii. Ownership of significant assets will also be considered with each application. Any person who has
reached the age of majority and is financially dependent on parents, guardian of other family members will
be evaluated for Free Care based on family income.
7. Free Care may be provided to patients who have not filed a formal application. These allowances can be
authorized when it is determined that extenuating circumstances surround the patient’s financial situation or
if it is determined that payment of the account would create a hardship or would otherwise be considered
inappropriate or unreasonable. This provision is not intended to be used as an alternative to the Free Care
application process, but to provide the necessary administrative flexibility to authorize special Free Care
Allowances, as deemed by administration to be appropriate. Patients who can not produce all documentation
will be reviewed on a case by case basis.
8. Patients have the right to appeal any decision made by the Free Care Committee. The procedure for
appealing a decision is listed in the Procedure section of this Policy and Procedure.
9. The Patient Accounts office will be responsible for maintaining statistics and reports for managerial control
and audit purposes. Monthly and year-to-date reports will be submitted to the appropriate Board of Directors.
PROCEDURE:
1. If a patient at time of pre-admission, admission or during the billing cycle indicates the inability to pay a selfpay balance, the Patient Access staff or the Patient Accounts staff will pursue the possibility of Free Care
consideration.
2. During the review for Free Care, all other means of receiving payment from third party payors will be
explored. If a patient qualifies for assistance through a federal, state or local agency, the staff counseling the
patient will help the patient apply for the appropriate program. If it appears that a patient should qualify for an
outside program, a denial from that program will be necessary before Free Care can be approved.
3. Candidates for free care must complete a Financial Interview Form. This application must include the
family’s income and asset.
a. Assets to be considered should be highly liquid assets, i.e. bank accounts (checking and savings), real
estate, stock and bonds, cash surrender value of life insurance, etc.
b. Income should include gross salaries or wages, tips, interest earned, dividends, pensions or any income
required on an IRS Form 1040. Proof of income will be supplied by the patient using one or more of the
following documents as examples:
1. Copy of most recent income tax return (1040)
2. Copy of most recent income statement (W-2)
3. Copies of most recent pay stub(s).
4. Signed statement from employer.
c. If none of the above proofs of income are available, then a letter of support from a third party may be
used. This must be accompanied by a notarized statement from the patients or guarantor (in the case of
a minor) stating they have no income.
4. Free Care applications will be submitted before the Free Care Committee for consideration and approval.
The committee will consist of the Vice President/CFO and the Director, Patient Financial Services. The
committee will meet monthly to approve or deny accounts for Free Care.
5. Patients that qualify for partial Free Care will be offered a payment arrangement for the remaining balance
due, based on the Credit and Collection Policy.
6. Free Care will be granted based on the Federal Income Poverty Guideline. Partial Free Care will be granted
using the sliding scale in Schedule A, Available at the Patient Accounts Office.
7. Free Care approval is based on income, family size and consideration of assets. The rules for determining
family size will be the same rules applied by the IRS in determining the number of dependents for each
taxpayer.
8. If Free Care is approved, the patient/guarantor will be notified, in writing, of the decision within 30 days. The
amount of Free Care consideration will be documented in the notice. If free care is awarded at less than
100% of balance due, the patient/guarantor may appeal the decision. The request for a reconsideration must
be in writing and include a reason for the appeal. The appeal request should be addressed to the St. Joseph
Hospital Free Care Committee.
9. Patients/Guarantors who are denied Free Care consideration may appeal the decision, in writing, to the Free
Care Committee. The written appeal must include a reason for the appeal not included in the original Free
Care application. All appeals will be reviewed by the Free Care Committee and written appeal decision will
be issued with 30 days.
Regulatory Responsibilities:
1. A list of Saint Joseph Hospital Emergency Room providers can be found on the Saint Joseph web site at
http://www.stjosephhospital.com.
2. All self pay patient accounts are eligible for a 40% reduction of charges.
Responsibility:
Vice President Finance/CFO and Director, Patient Financial Services
ATTACHMENTS:
Attachment #1 - Federal Poverty Income Guideline
INTERDISCIPLINARY COLLABORATION:
VP Finance/CFO, Director, Patient Financial Services, Director, Central Billing. Director, Planning/Marketing.