To further the Providence Oregon mission in meeting community need through the provision of financial assistance for medically necessary healthcare in a fair, consistent, respectful and objective manner to low-income patients who do not have insurance coverage.
Policy statement
Providence Health and Services in Oregon (Providence) is a Catholic health care organization guided by the fundamental mission, values, and vision of Providence Health and Services. It is both the philosophy and practice of Providence that medically necessary health care services are available to all individuals without delay regardless of their ability to pay.
Providence assists eligible persons without insurance coverage by waiving all or part of the charges for services provided by Providence.
Procedure for financial assistance
Communication to Patients
Providence communicates the availability of financial assistance in appropriate acute care settings such as Emergency Departments, registration areas, and on each hospital website.
All billing statements and statements of services will inform patients that financial assistance is available.
Signs are posted in all hospital admitting areas informing patients that financial assistance is available for qualifying patients who complete an assistance application. These signs inform patients that free or reduced cost care may be available to qualifying patients that complete an application.
Materials, including cards and brochures, are available in multiple languages specific to the geographic area of each hospital. Financial assistance policies and applications are also available on all PHS-OR hospital websites and by mail from the Regional Business office.
Financial counselors and business office personnel are available at each acute care facility and the Regional Business Office to help patients understand and apply for local, state and federal health care programs and the Providence Financial Assistance Program.
All Providence employees are informed annually how to refer patients to apply for the Providence financial assistance program. Annual staff education programs are provided to all Business office staff.
Patients can request Financial Assistance information by calling the Financial Assistance patient information phone line on a 24-hour basis. Voicemail is available and all calls will be followed up within three working days.
Uninsured patients are provided information regarding the availability of Financial Assistance on registration or admission to any PHS-OR acute care facility.
Applications for assistance, in the form of the Providence Financial Assistance questionnaires (FAQ), are available on all PHS-OR hospital websites, in acute care in-patient registration areas or via mail from the Regional Business office. The FAQ includes instructions on how to complete the form and the supporting documentation necessary to complete the application process. Instructions for return of the form are also provided. Contact phone numbers for assistance are also provided. The Providence FAQ is available in four languages.
Individuals other than the patient such as the patient's physician, family members, community or religious groups, social services, or hospital personnel may make requests for financial assistance on the patient's behalf.
Application Process
Completion of Financial Assistance Questionnaire (FAQ) –Patients wishing to apply for Financial Assistance are responsible to initiate and seek to complete the Financial Assistance (FA) process within 30 days of discharge. Completion includes filling out and submitting an FAQ, along with all requested documentation of income and assets.
Failure to initiate the Financial Assistance process - If the patient fails to initiate the Financial Assistance process, Providence may elect to begin collection activity including possible transfer to a collection agency. Prior to transfer to a collection agency, Providence will send a minimum of three statements and make two phone attempts to contact the patient at the address and phone number provided by the patient. Statements and communications will inform the patient of the amount due, of the opportunity to complete a Financial Assistance questionnaire and that the completion of the questionnaire may qualify the patient for free or reduced cost care.
Eligibility Determinations –Providence will inform patients of the results of their application within 60 days of receiving a completed application and all requested documentation. Final determination for financial assistance is provided to the patient in a written notice of determination (NOD).
Payment arrangements after Financial Assistance determination –Providence will continue to work with patients to resolve the remainder of their balance after financial assistance. Patients are responsible to make mutually acceptable payment plan arrangements with Providence within 30 days of their NOD (See payment plans).
Patient notification of transfer to a collection agency after payment plan arrangements - Providence will send a minimum of two statements to patients who have failed to make payment arrangements after NOD or who do not comply with mutually agreed to payment plans. The notice will alert the patient of their balance and that if their financial situation has changed, they may have the opportunity for a new payment plan. This communication will take place prior to transfer to a collection agency.
Stay of collection activities –Patients who have completed an application and are under review will have a stay of collection activity and any agency interest that may have accrued to their bills.
Late completion of an application –Patients may apply for Financial Assistance at any time up until legal judgment has been taken. Patients whose accounts have been transferred to a collection agency may request Providence Financial Assistance, complete an application with requested documentation and be considered for reduction of their bill.
Collection agency patient notification - Agencies will provide patients the Providence 24-hour phone number that patients may call to request Financial Assistance.
Interest – Providence will not charge interest to uninsured patients for accounts where the patient is fulfilling the terms of predetermined payment arrangements. Collection agencies interest requirements are not covered by this policy, with the exception of the stay of interest for accounts under Financial Assistance review.
Assistance after court judgment - Providence and collection agencies will not provide assistance after an account has received a final court judgment against it.
Determinations - The Providence Regional Business Office makes financial assistance determinations.
Eligibility Criteria for Uninsured Patient Financial Assistance
Financial Assistance employs a sliding scale discount that takes into consideration a patient’s household income and assets.
Eligible patients are uninsured persons who receive inpatient or outpatient medically necessary services from a Providence hospital in Oregon and who are not eligible for coverage that would otherwise pay for these services (whether through employer-based coverage, commercial insurance, government sponsored coverage or third-party liability coverage.) In addition, the patient’s Household income (as defined below) must be less than 400% of the Federal Poverty level and the financial assistance discount is subject to the limitation on Qualified Assets described in section C.7 and C.8 below.
Financial Assistance discounts are in addition to the uninsured discount.
Financial Assistance determinations will be consistent among patients, regardless of their age, sex, race, creed, disability, sexual orientation, national origin, or immigration status.
Providence Financial Assistance is intended to aid the resident members of communities served by Providence Health & Services in Oregon. A community resident is someone who resides within the primary service area of a Providence hospital. To be considered a community resident, patient must have resided within the primary service area for at least six months preceding the date when services are rendered. The requirement of six months’residence shall not apply to individuals who reside outside the primary service area of a Providence hospital in Oregon but who require emergency treatment while traveling or visiting within the primary service area.
Financial Assistance is generally secondary to all other financial resources available to the patient, including insurance, government programs, third-party liability, and qualified household assets.
Individuals with access to health insurance, third party reimbursement for health services or governmental assistance that elect not to enroll, fail to take advantage of or fail to maintain eligibility for such coverage may be excluded from receiving financial assistance.
Financial Assistance Determination Process
Financial assistance reduction of bills is in addition to the uninsured discount. The qualifying level of assistance is applied to charges after the uninsured discount has been applied. The uninsured discount is equal to the discount provided under the Providence Preferred-Oregon (PPOR) contract for the hospital where the patient received services. (See policy 516).
Sliding Scale Levels - Financial Assistance is determined based upon a sliding-fee scale and is subject to income and assets. In order to obtain financial assistance, the patient must establish (through completion of an FAQ and submission of required documentation) that the patients Household income is below 400% Federal Poverty Level (FPL) for the 12 months preceding the date of services. The discount provided per FPL income is provided below:
Federal Poverty Guideline
Percent of Assistance Discount
0 – 200 %
100%
201 – 300
70
301 – 350
40
351 – 400
10
Allowances may be made for extenuating circumstances based on each person’s unique life situation and mitigating factors. The amount of assistance provided by Providence may be more than outlined in the guidelines, but not less.
Documents used for income and assets verification for the household include but not be limited to: Copies of the most recent 90 days of payroll stubs, Social Security checks, or unemployment checks. Copy of the current IRS tax return filed. Current bank, trust fund statements. Mortgage statements and annual property tax statements. In the absence of income, a letter of support from individuals providing for the patient’s basic living needs. Upon request Providence may require additional verification of income and assets.
"Household Income" includes all pre-tax income however derived of all persons 18 years old and over who reside in a household.
"Household Assets" will be considered in the final determination of eligibility for financial discounts. Household Assets that will be considered include all cash or non-cash assets owned by a member of a household including:
Cash held in savings accounts, checking accounts, safe deposit boxes, or homes;
Value of trusts (including living trusts) the patient or guarantor has interest or ownership of equity in real estate;
Cash value of stocks, bonds, treasury bills, certificates of deposit and money market accounts;
Cash value of life insurance policies;
Personal property held as an investment, such as jewelry, coin collections;
Vehicles other than an automobile of reasonable value used as the primary source of transportation; and Lump sum or one-time receipts of funds, such as inheritances, lottery winnings, insurance settlements.
Application of Qualified Assets – An uninsured patient who is otherwise eligible for financial assistance will have the amount of the financial assistance discount reduced (or eliminated) by the amount (if any) that the patient’s "Qualified Assets" exceed the amount of the bill for which the patient otherwise would be responsible after the deduction of financial assistance discount.
Determination of "Qualified Assets" – Qualified Assets are determined by calculating one-quarter of the amount that remains after $75,000.00 is deducted from the total value of a patient’s Household Assets. For example, Qualified Assets = (Household Assets - $75,000.00) X .25%.
Providence may, request a credit history report to confirm the financial assistance information as needed.
Assignment to a collection agency for follow-up will not occur during the assistance determination process.
Incomplete financial assistance applications may be denied, until or unless they are completed. Providence will retain the incomplete application and send a letter to the patient outlining the information needed and how to submit the necessary paperwork.
Notification of Financial Assistance Determination
The Providence Business Office will make assistance determinations within 60 days of receiving a completed FAQ and all required documentation.
Notification of financial assistance determinations is mailed to the patient or responsible party.
Providence keeps all applications and supporting documentation confidential.
Payment Plans for Financial Assistance Patients
Guidelines for payment plan amounts – Providence will limit amounts collected from uninsured patients to no more than 20% of the patient’s Household Income per year, unless the patient household has Qualified Assets.
General lengths of terms for payment plans are outlined below. Plans will be modified so as not to exceed 20% of annual Household Income.
Amount Owed and Months to Pay
Approval
$ 1 - 250
$ 251-500
$501-1,000
$1,001-3,000
$3,001-5,000
$5,001-10,000
$10,001 +
FC & Self Pay Staff
3
5
7
12
18
18
24
Sup. Or Manager
4
8
12
18
24
24
30
Director
6
9
12
18
24
30
*
Uninsured patients meeting an agreed upon monthly payment plan are not assigned to a collection agency and will not be charged interest on the remaining balance.
Patients are responsible for communicating to the business office anytime an agreed upon payment plan may be broken. Lack of communication from the patient may result in further account collection action with appropriate patient notification.
Payment plans extending beyond the recommended timeframe are accepted based on supporting documentation, or adequate security with Director approval.
Payment plans extending beyond the recommended timeframe with no supporting documentation may be forwarded to the collection agency for extended payments. These may be interest free with no legal action pursued as long as the payment plan is maintained.
Collection Practices for Financial Assistance Patients
Providence makes all reasonable attempts to confirm that patients are not eligible for assistance programs prior to collection agency assignment.
Providence activity prior to transferring an account – Prior to transfer to a collection agency, Providence will send a minimum of 3 statements and make two phone attempts to the patient at the address and phone number provided by the patient. Statements and communications will inform the patient of their financial responsibility and of Financial Assistance.
In cases where a voluntary trust deed has secured a Providence debt, Providence does not execute a lien that forces the sale, vacancy or foreclosure of an assistance patient’s primary residence to pay for outstanding medical bills.
Appeals of Assistance Determinations
Patients or their representatives can appeal a financial assistance determination by providing additional information of eligibility determinations, such as income verification or an explanation of extenuating circumstances, to the business office director within 30 days of receiving notification. The Director of the Regional Business Office or the Regional Administrator of Oregon Patient Business Services reviews all appeals. The responsible party will be notified of the outcome.
Terms and definitions
Medically Necessary – refers to inpatient or outpatient health care services provided for the purpose of evaluation, diagnosis and/ or treatment of an injury, illness, disease or its symptoms, which otherwise left untreated, would pose a threat to the patients ongoing health status. Services must be clinically appropriate and within generally accepted medical practice standards; represent the most appropriate and cost effective supply, device or service that can be safely provided and readily available at a Providence hospital, with a primary purpose other than patient or provider’s convenience. Expressly excluded from medically necessary services are health care services that are cosmetic; experimental or part of a clinical research program; private and/or non -Providence Health & Services medical or physician professional fees; services and/or treatments not provided at a Providence hospital.
Commitment to uninsured – discounts
Objective
To further the Providence Oregon mission in meeting community need through the provision of an uninsured discount for medically necessary healthcare in a fair, consistent, respectful and objective manner to eligible patients who do not have insurance coverage.
Policy statement
Providence Health & Services in Oregon (Providence) is a Catholic health care organization guided by the fundamental mission, values, and vision of Providence Health & Services. It is both the philosophy and practice of Providence that medically necessary health care services are available to all individuals regardless of their ability to pay.
Providence assists any eligible patient without insurance coverage by reducing the usual and customary charges billed for services provided by Providence hospitals referred to as an “Uninsured Discount”.
Procedure for uninsured discount process
Uninsured Discount – Providence provides hospital patients who receive inpatient or outpatient Medically Necessary services from a Providence hospital in Oregon who are Uninsured with a discount equal to the Providence Preferred Rate for the Providence hospital where services were received. The Uninsured discount is updated annually.
Eligible patients - Eligible patients are uninsured persons who at the time services were provide, had no insurance coverage for, or right to, the payment of hospital care (whether through employer-based insurance, government sponsored coverage or third-party liability coverage.) The Uninsured discount is intended for residents of the communities Providence hospitals serve. A community resident is someone who resides within the primary service area of a Providence hospital. To be considered a community resident, patient must have resided within the primary service area for at least six months preceding the date when services are rendered. The requirement of six months’ residence shall not apply to individuals who reside outside the primary service area of a Providence hospital in Oregon but who require emergency treatment while traveling or visiting within the primary service area.
Other Financial Assistance - If paying a Providence medical bill creates a financial hardship, patients will be referred to the Providence financial assistance program. The uninsured discount has no bearing or impact on a person's ability to apply or qualify for financial assistance. Financial Assistance is applied to the Uninsured Discount rate.
Terms and Definitions
Medically Necessary - refers to inpatient or outpatient health care services provided for the purpose of evaluation, diagnosis and/ or treatment of an injury, illness, disease or its symptoms, which otherwise left untreated, would pose a threat to the patients ongoing health status. Services must be clinically appropriate and within generally accepted medical practice standards; represent the most appropriate and cost effective supply, device or service that can be safely provided and readily available at a Providence hospital, with a primary purpose other than patient or provider’s convenience. Expressly excluded from medically necessary services are health care services that are cosmetic; experimental or part of a clinical research program; private and/or non -Providence Health & Services medical or physician professional fees; services and/or treatments not provided at a Providence hospital.
