Metroplex Health System Charity Care
Metroplex Health System extends the healing ministry of Christ to all, regardless of their ability to pay. Patients unable to pay for services should consult Metroplex Health System financial counselors for assistance identifying available resources to meet financial obligations.
The Metroplex Health System charity care policy provides guidelines for financial assistance based on financial need to self-pay patients receiving emergency and other non-elective services for medical conditions that would cause patients harm without immediate attention. These services apply to Emergency Department Outpatients, Emergency Department Admissions and follow-up care relating to previous emergency visits. Assistance may range from full write-off to discounted care and is in addition to other discounts offered by Metroplex Health System.
All or a portion of emergency and non-elective services may be considered for charity if certain conditions exist.
Please click here to see the list of conditions.
Metroplex Health System's charity care policies are transparent and available to all in compliance with the Language Assistance Services Act. Signage is posted prominently at all points of admission and registration, including the emergency department. Written information about the Hospital's financial assitance policy and copies of the financial assistance form are available in admission and registration areas. The Hospital's financial assistance policy, application form, and financial counselor contact information are also posted on the hospital's website.
Patient collections communications also inform patients of the availability of financial assistance. Each bill, invoice, or other summary of charges to an uninsured patient includes with it or on it a prominent statement that an uninsured patient who meets certain income requirements may qualify for financial assistance and information on how to apply for assistance under the Hospital's financial assistance policy.
Metroplex Health System provides financial counselors to those who are considered "self-pay." Billing statements also include instructions on how to obtain financial assistance.
Both Metroplex Health System and the patient are accountable for their role in the charity care process.
Metroplex Health System is responsible for evaluating patient eligibility for financial assistance based on the charity care policy as well as notifying the patient on payment options while honoring the patient’s right to appeal decisions.
Correspondingly, patients are responsible for providing accurate information and all documentation necessary to apply for financial assistance. Please click here to read about patient responsibilities in full.
When determining patient eligibility for charity care, Metroplex Health System promises to be equitable, consistent and timely. Requests for financial assistance will be accepted up to six (6) months from the date the first statement is remitted to the patient.
Requests may be received from multiple sources. Requests received from a third party will be directed to a financial counselor who will secure proper clearance from the patient and then work with the third party on the patient’s behalf.
Metroplex Health System financial counselors attempt to contact all registered, self-pay inpatients during their hospital stay in order to assess needs. The registration and pre-registration process for patients will promote the identification of those patients that are potentially eligible for financial assistance. Patient's inquirires about the application process for financial assistance can be made at any time of registration or pre-registration or at any point in the care continuum. In addition, Metroplex Health System may utilize internal staff or third party agents to assist patients in securing Medicaid coverage if eligible. Patient collections communications also inform patients of the availability of financial assistance.
All patients requesting financial assistance will be required to complete Metroplex Health System's Financial Assistance Application Form in order to establish eligibility. Patients may be eligible for charity care if they are uninsured and represented by specific circumstances. Please click here to read a full list of these circumstances.
- Patient is homeless.
- Patient is deceased and has no known estate able to pay hospital debts.
- Patient is incarcerated for a felony.
- Patient is currently eligible for Medicaid but was not at the date of the healthcare service.
- Patient is eligible by the State to receive assistance under the Violent Crime Victims Compensation Act or Sexual Assault Victims Compensation Act.
- Patient is eligible for the Centers for Medicare and Medicaid funding for certain emergency health services provided to undocumented aliens in accordance with the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Section 1011, regardless of whether Section 1011 funds for the applicable state are exhausted.
- Patient has a payment risk score of "D" or "E" based on the Scorer® application.
The completed Financial Assistance Application Form,will be submitted to the Metroplex Health System Patient Financial Services (PFS) department for processing. PFS requires proof of income including employer pay stubs, employer verification and/or IRS tax return summary. In addition, Medicare beneficiaries are subject to an additional asset test in accordance with Federal Law. This review is completed to determine patient eligibility based on the patient’s total resources (including but not limited to family income level, assets [as required for Medicare patients] and other pertinent information).
Charity care approvals will be made according to Metroplex Health System Charity Care Guidelines. Charity care reductions will be applied to the amount a patient is charged for their hospital/medical services. The amounts charged to patients who are eligable under Metroplex Health System's charity care policy will not be more than the amounts generally billed to individuals who have insurance covering such care. To be eligible for a 100% reduction from charges, patients must have a household income at or below 200% of the current Federal Poverty Guidelines. Patients with a household income exceeding 200% but less than 400% will be eligible for a sliding scale discount. The minimum discount for self-pay payments of non-elective services will be 30% with an additional discount opportunity for prompt payment. An asset test is mandatory for Medicare patients. The Medicare patient is responsible for the greater of: 1) Seven percent (7%) of Available Assets (defined as cash, cash equivalent and non-retirement investments) or 2) Required payment per the Charity and Self-pay Discount Worksheet for Non-Elective services.
When determining the patient’s income, the household size and income includes all immediate family members and other dependents in the household. This includes an adult (and spouse if applicable), natural or adopted minor children of adult or spouse, students over 18 years of age dependent on the family for over 50% support, and any other persons dependent on the family income for over 50% support. (A current tax return of the responsible adult is required.) Income may be verified by submitting a personal financial statement, copies of W-2, 1040 forms, bank statements or any other form of documentation that supports reported income.
Charity applications processed by PFS are reviewed by Metroplex Health System's Charity Care Committee monthly. The patient will be notified of eligibility for charity care generally within 60 days of receiving a completed application and all required supporting documentation. If the patient disagrees with the decision, he or she may request an appeal in writing within 45 days of the denial and include any additional relevant information that may assist in the appeal evaluation. For those patients who have applied for Medicaid, collection activity will be suspended during the consideration of a completed application. This practice is a courtesy and does not alleviate the financial obligation.
Patients receiving partial financial assistance who are unable to pay the full amount of any self-pay balance in one payment will be offered a reasonable payment plan. Payment plans for partial charity accounts will be individually developed with the patient. No interest will accrue to an account balance while payments are being made, unless the patient has voluntarily chosen to participate in a long-term payment arrangement that bears interest. If, in violation of the patient's payment plan, the patient does not make three consecutive monthly payments on any self-pay balance, the patient's account may be referred to collections. Two separate incidents of missed scheduled payments within one year may also result in the patient's account being referred to a collection agency.
All collection activities conducted by the Hospital or its third-party agents will be in conformance with all federal and state laws governing debt collection practices. In general, collection agency activity will be in the form of letters, telephone calls, or credit reporting. Collection agencies will not contact patients between 4 p.m. on Fridays and 5 p.m. on Sundays. Liens attached to insurance (auto, liability, life and health) are permitted. No other personal judgements or liens will be filed against non-elective self-pay patients by the Hospital for those with an annual family income of less than 400% of Federal Poverty Guidelines.
Careful records are kept of all charity care transactions.
The provision of charity care may now or in the future be subject to federal, state or local law. Such law governs to the extent it imposes more stringent requirements than this policy.
For further information, call (254) 519-8155.