DISCOUNTED/SLIDING FEE POLICY

Lewis Health Center and its FQHC sites of PrimeCare, Lewisburg Family Practice, Lewisburg Pediatrics and Primary Care-Waynesboro

It is the policy of Lewis Health Center and its FQHC sites to provide quality health care regardless of the patient's ability to pay. Discounts are offered based upon household income and size. A sliding fee schedule is used to calculate the basic discount and is updated April 1 using the current federal poverty guidelines. Once approved, the discount will be honored up to one year or through March 31 (whichever comes first) after which the patient must reapply.

Affordable Care is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with LHC’s procedures for obtaining affordable care or other forms of payment or financial assistance, and to contribute to the cost of their care based on their individual ability to pay.

Patients will be required to assign or pay, to the clinic, all insurance payments or liability settlements designated as remuneration for medical expenses.

DEFINITIONS:

Affordable Care: Affordable Care results from a provider’s policy to provide healthcare services  at a discount or free to the individual who meets the established criteria.

Family: A group of two or more people who reside together and who are related by birth, marriage, or adoption. According to the Internal Revenue Service rules, if a patient claims someone as a dependent on their income tax return, they may be considered a dependent for the purposes of the provision of sliding fee discount policy.

Family Income: Family Income is determined using the following guidelines.

• Includes earnings, unemployment compensation, worker’s compensation, Social Security, Supplement Security Income, public assistance, veteran’s payments, survivor benefits, pension, or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources:
• Noncash benefits (such as food stamps and housing subsides) do not count;
• Determined on a before-tax basis;
• Excludes capital gains or losses;
• Non-relatives, such as house mates, do not count.
• Self employed applicants income will be calculated using the most recent federal income tax return

Uninsured: The patient has no level of insurance or third party assistance to assist with meeting his/her payment obligations.

Underinsured: The patient has some level of insurance or third party assistance but still has out-of-pocket expenses that exceed his/her financial abilities.

Nominal Fee: For those patients qualifying at or below 100% of FPG will be charged a $20.00 nominal fee.

Any patient that is uninsured/underinsured, are those who are ineligible for any government health care benefit program and who are unable to pay for their care, based upon a determination of financial need in accordance with this Policy. The granting of affordable care (sliding fee) shall be based on an individualized determination of financial need and shall not take into account, age, gender, race, social status, sexual orientation, or religious affiliation.

Sliding Fee Discount Application Process

A complete application including required documentation of the home address, household income, and insurance coverage must be on file and approved by the Business office before a discount will be granted. If the applicant appears to be eligible for Medicaid, a written denial of coverage by Medicaid may also be required.

Patients must provide proof of income 30 days from date application was given.

LHC shall process requests for sliding fee discounts promptly and will notify the applicant in writing upon their determination.

Once an application has been approved, any visits within 6 months of the dated application with outstanding charges (or no later than the date the LHC clinic was designated an FQHC) will be given the sliding fee discount. 

Appeals Procedure: If an applicant is denied, the applicant may appeal the denial, in writing, within 30 days of the denial date. Once written appeal is received, the application with be re evaluated by the Business Office Supervisor/Practice Manager and/or FQHC Controller/Director. A written response to the denial will be provided to the patient and will indicate either approval or the upholding of the denial.

Acceptable Proof of Income Forms Include but are not limited to:

• Recent check stubs (last two check stubs)
• W2
• Signed Letter from employer stating wages (hours and rate of pay)
• If self-employed, a copy of the most recent federal tax return
• Social Security Award letter or Current Bank Statement showing deposit
• Veteran’s pension award letter or copy of Veteran check
• Letter from social security office stating monthly benefit
• Child support award letter or court order document
• Unemployment compensation letter/check
• Award letter from unemployment office indication weekly benefit
• Copy of worker’s compensation check
• Current Food Stamp qualification letter (no older than one year).

Adolescent patients seeking confidential care are exempt from the application process, and services are provided at the nominal rate or under the guidelines of the Free care procedure.

The need for assistance shall be re-evaluated every 12 months or April 1st (whichever comes first) , meaning that visits occurring within 12 months or prior to April 1 of a previous approval will received the approved sliding fee discount.

LHC understands that patient’s financial situations may change; therefore, LHC reserves the right to reevaluate previous sliding fee discount approvals based on more current information. The reevaluations will be handled on case-by-case basis.

No discount will be applied if application is returned incomplete. Incomplete applications will result in a denial of the application.

LHC Sliding Fee Scale Chart to be updated annually with current HHS Poverty Guidelines and approved by LHC Advisory Board, a subcomponent of MRMC Board of Trustees prior to April 1st of each year.

Services may be written-off the LHC A/R when approved at the following levels:

Patients Unable to Pay at Time of Service:

Patients who arrive at the Center in need of health care services but unable to pay amount for their visit will initially be screened by the clinical manager or other qualified clinical personnel to determine whether the patient has a condition which makes it a medical necessity for him/her to be presently seen:

If the visit is determined to be medically necessary:

• Registration personnel should determine whether the patient might be eligible for “free care”, as specified elsewhere in this policy
• Absent “free-care” eligibility, the Registrar’s manager or his/her superior may determine the patient has other exceptional circumstances that warrant them being allowed to be seen without payment at the time of service (e.g. the patient is a regular patient whose account indicates that they have consistently paid for their visits as required), with the understanding that they are still responsible for payment of the visit and that all non-medically necessary future visits will not be scheduled until payment for that visit is satisfied. An Acknowledgement of Financial Responsibility should be signed by the patient to evidence their understanding of this liability for payment.

If the visit is determined not to be medically necessary:

• If it had been scheduled visit, LHC will honor such scheduled visit on a one time basis, with the understanding that the patient is still responsible for payment of the visit and that all non-medically necessary future visits will not be scheduled until payment for that visit is satisfied. An Acknowledgement of Financial Responsibility should be signed by the patient to evidence their understanding of this liability for payment.
• If the visit is merely a non-emergent walk-in visit, the patient will be offered the opportunity to reschedule his visit for a later date with the understanding that payment will need to be made at the time of visit.

When a patient is able to pay only a partial amount toward the total due for the current visit or on an account balance, the financial counselor or FQHC’s financial management (Office Manager, Controller, or Director) can approve a payment plan for the outstanding balance. Patient would then be able to be seen at the current visit.

Note: These limitations are applicable to each date of service for each admission or procedure.

Free Care:

Patients will be given free care on a case by case basis when FQHC’s financial management (Office Manager, Controller, or Director) determines that the patient’s current circumstances warrant that they not be liable for payment for services rendered during the current visit. Such circumstances could include but are not limited to Personal/family natural disaster – home damaged by fire, tornadoes, flooding; Personal/family financial crisis – loss of primary source of household income; Immediate family death. Merely not having money in one’s possession does not constitute an adequate basis for free care.

Prompt Payment Discounts:

Patients, during normal contact with FQHC personnel, will be offered a 10% discount for paying their identified portion of the bill in full prior to, or at time of service. If unable to identify balance prior to or at time of service, a 10% discount will be offered within 30 days of first billing statement.

LHC reserves the right to amend and/or update this policy at any time.
Both sliding fee scale, Free Care, and discounts will be administered through the Business Office Supervisor/Clinic Manager and/or the FQHC Controller/Director.
Any discounts, adjustments, or amendments outside of this policy must be approved by LHC Administration and LHC Advisory Board, a subcomponent of MRMC Board of Trustees.