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CHARITY CARE
All Pittsburgh hospitals have a charity care program but they are not currently obligated to consistently distribute charity care monies so it can be difficult to access these monies. Meeting the income requirements does not guarantee receipt of charity care. That said, the guidelines are usually similar to those listed below. Consumer health organizations may be helpful if you are having problems accessing charity care, see listings below.
WEST PENN ALLEGHENY HEALTH SYSTEM
Charity Care Under the Account Assistance Program
The WPAHS Charity Care Program exists to provide partially or fully uncompensated medical services to patients in financial ‘need.’ Charity Care is offered to patients who demonstrate, through completion of an Account Assistance Application, an inability to pay and not, an unwillingness to pay. Patients that may be eligible for Medical Assistance, or other insurance coverage, e.g., Adult Basic, are expected to enroll and are assisted with the application process. Patients should exhaust all insurance coverage opportunities prior applying for Charity Care. Applicable to all WPAHS hospitals. Available through completion and timely submission of the Account Assistance Application including required supporting documentation to validate income, asset and medical indigence. Patient/Family cooperation is required during the application submission and review process. Application renewal may be required on services rendered outside of application periods (generally 90 day coverage period.)
Available to citizens of the United States of America with some provisions for international patients who might otherwise quality for state coverage. Applicable generally on urgent and emergent medical services.
Cosmetic, office type dental and other services where separate established payment guidelines and balances exist, may not applicable. Application review process is standardized, and involves management oversight.
The provision of Charity Care is considered on hospital accounts for those patients whose income/assets and medical indigence (or a combination of) meet the criteria set forth by WPAHS Charity Care guidelines.
Charity Care adjustments apply to patient liability amounts only and may be a result of, but, not limited to uninsured, underinsured, and patients not eligible for Medical Assistance benefits; Balance after insurance where out of pocket expense is $1,000 or greater; Medical debt incurred within the system qualifies the patient under medical indigence; Excessive medications, terminal illness and/or multiple hospitalizations.
Estate exhaustion/insolvency; and, Homelessness status.
Full or 100% Charity Care adjustments are available to patients whose household income falls at or below 200% of the Federal Poverty Guidelines, regardless of insurance coverage and meet asset review.
Allowable Income Limit 200%
Number in Family Maximum Income
1 $19,600
2 $26,400
3 $33,200
4 $40,400
5 $46,800
Patients with household incomes below 100% Federal Poverty Guidelines are assisted and encouraged to apply for Medical Assistance benefits.
Partial (60% and greater) Charity Care adjustments are available to patients whose household income falls between 200-400% of the Federal Poverty Guidelines. Some restrictions related to insurance status and balance may be applicable as well as asset review.
Allowable Income Limit 400%
(double amounts in table above)
Case by case review based on asset to debt ratios may be considered for either partial or full (100%) charity care adjustment.
Physicians providing professional services to patients may offer charity care adjustments. Patients must contact their physician’s office to determine their discount policies.
Patients who are interested in speaking with Customer Service Representatives regarding their account balances or, who may have further questions regarding West Penn Allegheny Health System’s Account Assistance Program should contact the following:
Allegheny General and Suburban Campus and West Penn and Forbes Campus Hospitals:
Customer Service Department: 1-800-547-0540
Days and Hours of Operation: Monday thru Friday, 8:30am to 4:30pm
UPMC FINANCIAL ASSISTANCE PROGRAM
The following is a summary of UPMC’s Financial Assistance Policy, effective July 2005:
It is the policy of the University of Pittsburgh Medical Center to provide financial assistance for patients who:
* have limited or no health insurance
* have applied for but are deemed ineligible for governmental assistance (e.g., Medicare or Medicaid)
* cooperate with UPMC by supplying UPMC with pertinent information about household finances
* demonstrate financial need
UPMC offers financial assistance to eligible individuals and families. This assistance applies to emergency care and to services that are medically necessary but not of an emergent nature. Depending on the individual’s need, either free care or reduced patient financial obligations may be offered, applicable to certain UPMC physician charges as well as hospital services. UPMC does not have the authority to waive any charges from physicians or other health professionals who are not employed by UPMC.
In determining a reasonable and fair payment, UPMC applies a sliding scale. If a patient’s income and assets combined are below 400% of the federal poverty guidelines, the patient will receive some form of financial assistance.
* If a patient’s income and assets combined fall below 200% of the federal poverty guidelines, the patient will have no financial responsibility for care provided; the fees for UPMC services are completely waived.
* If a patient’s income and assets combined fall between 201% and 300% of the federal poverty guidelines, the patient is eligible for financial assistance in the form of an 80% reduction in charges. This means that the fees for UPMC services are limited to a maximum of 20% of the charges.
* If a patient’s income and assets combined fall between 301% and 400% of the federal poverty guidelines, the patient is eligible for financial assistance in the form of a 70% reduction in charges. This means that the fees for UPMC services are limited to a maximum of 30% of the charges.
* If a patient’s income and assets combined fall above 400% of the federal poverty guidelines, the patient is eligible for financial assistance in the form of a 20% reduction in charges. This means that the fees for services are limited to a maximum of 80% of the UPMC charges.
UPMC also considers financial assistance in cases of medical hardship where the patient’s medical bills are so great that they threaten the patient’s financial survival.
Certain medical procedures are excluded; some examples are cosmetic surgery when it is not medically necessary, bariatrics, acupuncture, in vitro fertilization, and procedures not deemed medically necessary. Financial assistance is not available to international patients.
If you have a financial reason why you cannot pay for services, call:
UPMC Financial Assistance Program
1-800-854-1745
Financial counselors are available to help you with any questions and walk you through the process. Also, we can give you a Financial Assistance application for your review and completion.
