Financial Assistance Policy

York Hospital is a non-profit healthcare provider. We’re committed to providing financial assistance to every person in need of medically necessary treatment even if that person is uninsured, under insured, ineligible for government programs, or unable to pay based on their financial situation.

The purpose of this policy is to establish guidelines for financial assistance for patients who incur significant financial burden as a result of the amount they are expected to owe “out of pocket” for medically necessary health care services. York Hospital will provide emergency care to patients regardless of their ability to pay. We will accept a variety of payment methods and will offer resources to assist in resolving outstanding balances. We’ll assist patients in applying for known programs of financial assistance that may be applicable. We’ll treat all patients with kindness, respect, and compassion.

Definition of financial assistance

Financial Assistance is care provided to a patient with a demonstrated inability to pay. In accordance with the guidelines put forth by the Maine Department of Health and Human Services, York Hospital is required to provide free care to residents of Maine whose income falls on or below 150% of the poverty level guidelines. York Hospital provides free care at 200% or below the federal poverty guidelines as outlined below.

Financial Assistance may include unpaid co-insurance and deductibles if the patient meets the financial assistance eligibility requirements. A service rendered to a patient in which payment was anticipated but not received is considered bad debt. These patients are considered able to pay and therefore do not meet the criteria for financial assistance.

Eligibility criteria

In accordance with the guidelines put forth by the Maine Department of Health and Human Services, York Hospital is required to provide free care to residents of Maine whose incomes fall on or below 150% of the poverty level guidelines. York Hospital provides free care at 200% or below the federal poverty guidelines as outlined below.

For family units with more than six members, add $5,380 for each additional member.

• You must have a billed service from York Hospital.
• You must have a billed service from York Hospital.
• Only York Hospital-owned Physician Practices and York Hospital Facilities are covered through the Financial Assistance Program. Please call if you have any questions on what is covered.
• All services must be considered medically necessary as determined by York Hospital to be part of the Financial Assistance Program.
• If you are eligible for the Financial Assistance Program, the Program will cover bills within the 240-day time frame. (Rev. Jan. 2019).
• This Program does not cover prescriptions. Medications may be purchased through the York Hospital pharmacy if you do not have other prescription coverage.
• The patient’s potential eligibility for governmental or other coverage will be assessed. This may include Medicaid and Health Insurance Market Exchange coverage.

If you need help with medications please contact our Prescription Support Program at (207) 351-6252. YH Financial Assistance Program term runs annually from January 1 – December 31.

What is not covered?

• Cosmetic plastic services
• Outside labs and physicians not employed by York Hospital
• Does not provide or act as a substitute or supplemental for health insurance
• Does not guarantee benefits
• Does not cover medical care providers not employed or contracted by York Hospital

Definitions

• Bad debt: Any bill submitted for payment by a third-party payer or patient which is not paid in full and is unlikely to be paid.
• Emergency care: Immediate care which is meant to prevent further decline in the patients’ health or loss of life, loss of limb, or serious permanent injury to the patient’s body or bodily functions.
• Family: Two or more people who reside together and are related by birth, marriage, or adoption. (Rev. Jan. 2019)
• Family income: Total income from all people living in a particular household. Income refers not only to the salaries and benefits received, but also to receipts from any personal business, investments, dividends, and other income.
• Federal poverty income guidelines, FPL: The set minimum amount of gross income that a family needs for food, clothing, transportation, shelter, and other necessities. In the U.S, this level is determined by the Department of Health and Human Services. FPL varies according to family size.
• Gross charges: The full dollar amount of charges for all services rendered to patients.
• Medically necessary: A covered health service or treatment that is to protect and enhance the health status of a patient and could adversely affect the patient’s condition if omitted, in accordance with accepted standards of medical practice.
• Underinsured: Patient with some form of health insurance, but who may lack the financial ability needed to cover out-of-pocket medical care expenses.
• Uninsured: One who does not have or is not covered by an insurance policy.
• The basis for calculating amounts charged to patients: Patient charges are calculated based on resource utilization by applying a multiplier based on Medicare rates.

Application process

York Hospital will provide a discount to any qualified patient applying for financial assistance and has a family income of not more than 200% at or below the federal poverty income guidelines for all medically necessary services.

Apply for financial assistance

In accordance with procedures that involve an individual assessment of a patient’s financial need, steps may include:

• Filling out this application and submitting required personal and financial documentation utilized in the determination of an applicant’s financial need.
• Utilizing public data sources that provide information on a patient’s ability to pay. (Rev. Jan. 2019)
• Review of outstanding accounts and payment histories.

Applications will be processed using State of Maine and York Hospital Financial Assistance guidelines.

Criteria for financial assistance

1. Evaluation for financial assistance is available for anyone indicating the inability to pay a medically necessary bill.
2. Medicaid and Health Insurance exchange eligibility will be assessed.
3. Financial Assistance Program applications are available by calling (207) 351-2398.
4. Financial Assistance Applications should be completed by York Hospital within 30 days of all required documents and signatures being received.
5. A written notification will be provided to each applicant upon a determination of benefits.

Verification of income

Information requested for verifying an individual’s income for acceptance into the Financial Assistance program may include but is not limited to an Income Tax Return and year-to-date earnings information, as well as the latest calendar year proof of income for the entire household applying for FAP, chosen from the following:

• Current Pay Stub showing a year to date total for current year
• Profit and Loss Statement if self-employed
• Copy of monthly social security check or pension check
• Copy of bank statement showing direct deposit of social security or pension benefits
• Copy of current social security benefit statement
• Copy of unemployment check or benefit statements
• Copy of child support payments received
• Letter from employer
• Documentation with date Medicaid application was sent

Hospital collection efforts

Accounts with self-pay balances that show no evidence of patient payments or eligibility for financial assistance that have completed a patient billing cycle (120 days approximately) may be transferred to a collection agency. Any patient account that has applied for York Hospital financial assistance programs and supplied all required documentation will be held in a pending status with the collection agency until a determination is made.

1. It is possible for an account that has followed a complete collection cycle (240 days) to be reclassified into the financial assistance program as long as there is an established process for the patients’ inability to pay.
2. A patient eligible for financial assistance may not have been identified before being sent to outside collections. Therefore the collection agency working for York Hospital is aware of our financial assistance policy so that they may also identify these accounts with the inability to pay. (Rev. Jan. 2019)
3. Those patients who are uninsured at or below York Hospital’s financial assistance guidelines shall not be threatened by the collection agency with wage garnishment or liens on primary residences to collect unpaid medical bills.
4. A payment plan can be established at the request of the patient if the patient’s financial status indicates an ability to pay and, therefore, a financial assistance application is not necessary.
5. If requested documentation required for determining a patient’s financial assistance eligibility is requested and not returned within 30 days and every reasonable effort has been exhausted, the patient will be considered non-cooperative and the account may then be sent to collections.
6. York Hospital will not impose extraordinary collections actions such as wage garnishments, liens on residences, or other legal action for any patient without first making reasonable efforts to determine whether that patient is eligible for financial assistance under this policy.

Eligibility period

YH Financial Assistance Program term runs annually from January 1st to December 31st. Financial Assistance coverage for a patient must prove financial eligibility for all dates of service that are to be considered for charity.

Denial of financial assistance

Applicants denied for Financial Assistance will be provided a written letter along with a dated statement with the denial reason for all applicants denied FAP. If the denial was received due to incomplete documentation being received, the letter will state this and the applicant will have 60 days from the date of the notice to furnish the required information. If the application is not complete by the end of the 60 day period it will continue to progress through the billing process.

Financial assistance programs

• FAP: York Hospital Financial Assistance Program runs yearly January 1 – December 31 of the following year. You must notify York Hospital of any Insurance or State or Federal program that can be billed for the services you are requesting Financial Assistance for through this program. In accordance with the guidelines put forth by the Maine Department of Health and Human Services, York Hospital is required to provide free care to residents of Maine whose incomes fall on or below 150% of the poverty level guidelines. York Hospital provides free care at 200% or below the federal poverty guidelines.
• HELP: The York Hospital HELP program provides a discount for uninsured patients who have at least one outstanding bill with a minimum balance of $2,500, and payment must be made in full (one installment) within 60 days of the date of the discounted bill. (See Payment Grid)
• 40% self-pay discount: York Hospital provides a 40% discount for all eligible, uninsured self-pay balances.
• Payment plans: York Hospital offers a variety of payment plan opportunities, interest free.
• Long-term payment plan: All outstanding balances are combined into one bill, and a payment plan is established. This will take longer than 10 months to pay

Communicating the financial assistance policy to our patients and community

The Notice of York Hospitals Financial Assistance Policy shall be distributed by means of posting notices in prominent, well-traveled patient locations while also being placed in the information section of patient statements. The Financial Assistance Policy will also be made readily available on the York Hospital website and on brochures in common patient locations. These notices will be posted in the language most commonly spoken by the surrounding community.

Confidentiality

Any and all information relating to and contained within the financial assistance application will be kept confidential and be kept on record in a secure manner for approximately 7 years.

Regulatory requirements

In implementing this policy, York Hospital will comply with any and all federal, state, and local laws and regulations that may be applicable to activities pursuant to this policy.