Charity Discount Policy

A. Definitions

Patients with High Medical Costs – patients that incur out-of-pocket costs exceeding 10% of their family income in the prior 12 months excluding Essential Living Expenses and, for purposes of the charity discount, whose family income is at or below 200% of the Federal Poverty Level. The 10% threshold may be documented in 2 ways 1) the out-of-pocket costs are incurred at the hospital; or 2) the patient provides documentation of the patient’s medical expenses paid by the patient or the patient’s family in the prior 12 months.

"Essential Living Expenses" – any of the following expenses: rent or house payment and maintenance, food and household supplies, utilities and telephone, clothing, medical and dental payments, insurance, school or child care, child or spousal support, transportation and auto expenses, including insurance, gas and repairs, installment payments, laundry and cleaning and other extraordinary expenses.

Patient’s Family (for purposes of determining “family income”) – For persons 18 years or older, spouse, domestic partner as defined in Section 297 of the Family Code, and dependent children under 21 years of age, whether living at home or not. For persons under 18 years, parent, caretaker relatives and other children under 21 years of age of the parent or caretaker relative.

B. Eligible Patients

Patients receiving Non-Elective Care may qualify for a charity:

  1. Under insured patients (i.e., those patients with some form of third party payer coverage for health care services but such coverage is insufficient to pay the current bill) a household income that is at or below 200% of the Federal Poverty Level, and
  2. Uninsured patients Those patients with no third party payer coverage for health care services, with High Medical Costs and whose household income is at or below 200% of the Federal Poverty Level.
  3. Medically Indigent – Based upon state guidelines or requirements the patient meets the medically indigent status and whose yearly income or whose family’s yearly income exceeds 350% of the Federal Poverty Level

An initial screening must be completed to determine whether any portion of the patient's medical services can be paid by any federal, or state governmental health care program (e.g., Medicare, Medi-Cal, Champus, Medicare Secondary payer), California Health Benefit Exchange health plan coverage, private insurance company, or other private, non-governmental third-party payer. A charity discount can be applied to any account after the outstanding payer liability is satisfied (payment has been received and posted to the account).

C. Income Verification: All patients shall complete a Financial Assistance Application to assist in the determination of charity care for:

  • any prior dates of service where there is an outstanding patient balance that meets the charity requirements in all other aspects.
  • use related to accounts across multiple facilities (at the discretion of the manager)
    1. Medicare Patients

    All Medicare inpatient and outpatient accounts will be required to have supporting income verification documentation. Medicare requires independent income and resource verification for a charity care determination with respect to Medicare beneficiaries.

Uninsured Charity Discount Policy

An uninsured discount is available to the following California patient accounts:

  1. All Self Pay or uninsured patient accounts, excluding elective cosmetic procedures, facility designated self-pay flat rate procedures and scheduled/discounted procedures for International patients;
  2. Accounts where insurance benefits have been exhausted or terminated;
  3. Medicare outpatient self-administered drugs;
  4. All “Insured Patients with High Medical Cost” will be eligible for an Uninsured Discount per the details provided below; and
  5. Uninsured Patients whose family income exceeds 350% of the Federal Poverty Level are eligible for a managed-care PPO like Uninsured discount.

A. Definitions

Patients with High Medical Costs – patients that incur out-of-pocket costs exceeding 10% of their family income in the prior 12 months excluding Essential Living Expenses and, for purposes of the uninsured discount, whose family income is between 201% and 350% of the Federal Poverty Level. Patients are eligible for this designation even if they receive a discounted rate as a result of third-party coverage. The 10% threshold may be documented in 2 ways 1) the out-of-pocket costs are incurred at the hospital; or 2) the patient provides documentation of the patient’s medical expenses paid by the patient or the patient’s family in the prior 12 months.

“Essential Living Expenses” – any of the following expenses: rent or house payment and maintenance, food and household supplies, utilities and telephone, clothing, medical and dental payments, insurance, school or child care, child or spousal support, transportation and auto expenses, including insurance, gas and repairs, installment payments, laundry and cleaning and other extraordinary expenses.”

Patient’s Family (for purposes of determining “family income”) – For persons 18 years or older, spouse, domestic partner as defined in Section 297 of the Family Code, and dependent children under 21 years of age, whether living at home or not. For persons under 18 years, parent, caretaker relatives and other children under 21 years of age of the parent or caretaker relative.

“Reasonable Payment Plan” – means monthly payments that are not more than 10 percent of a patient’s family income for a month, excluding deductions for Essential Living Expenses.

B. Eligible Patients

All Self Pay patient accounts and all insured Patients with High Medical Costs accounts will be eligible for an uninsured discount, with the exception of elective cosmetic procedures; facility designated self-pay flat rate procedures, scheduled/discounted procedures for International patients and, accounts eligible for the charity discount.

C. Documentation of Income:

To support a patient’s income relative to the Federal Poverty Level, documentation in the form of recent pay stubs or income tax returns is required. Patients must make a reasonable effort to provide hospital with documentation of income and health benefits coverage. If the patient fails to complete a Financial Assistance Application, the hospital could consider the patient to be above 350% of the Federal Poverty Level.