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Pittsburgh hospitals have patient assistance programs to help low-income, uninsured patients pay hospital bills. They often do NOT offer this information. Ask! These programs are called charity care, patient assistance, financial assistance… If you apply and are denied, contact a consumer health advocacy organization such as the Pennsylvania Health Law Project listed in this booklet to appeal.

Call for income guidelines and application procedures.

 MERCY HOSPITAL MERCY CARE

412-232-5759

UPMC FINANCIAL ASSISTANCE

1-800-854-1745
Call for info and application.
You may also speak with a social worker at UPMC’s hospitals about financial assistance.

“It is the policy of UPMC to provide financial assistance for
patients who:

- have limited or no health insurance
- have applied for but are deemed ineligible for governmental assistance (for example, Medicare or Medicaid)
- demonstrate financial need
- reside in western Pennsylvania and/or the primary service area of a UPMC provider
- supply UPMC with pertinent information about household finances

“Financial assistance applies to emergency care and to services that are considered medically necessary(emphasis Be Well!.)  Depending on the individual’s need, either free care or reduced patient financial obligations may be offered, and may extend to UPMC physician charges as well as UPMC hospital services.”

“In determining a reasonable and fair level of assistance, UPMC applies a sliding scale. If a patient’s income and assets combined are below 400 percent 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 percent 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 percent of the federal poverty guidelines, the patient is eligible for financial assistance in the form of an 80 percent reduction in charges. This means that the fees for UPMC services are limited to a maximum of 20 percent of the charges.
- If a patient’s income and assets combined fall between 301 and 400 percent of the federal poverty guidelines, the patient is eligible for financial assistance in the form of a 70 percent reduction in charges. This means that the fees for UPMC services are limited to a maximum of 30 percent of the charges.
- If a patient’s income and assets combined fall above 400 percent of the federal poverty guidelines, the patient is eligible for financial assistance in the form of a 20 percent reduction in charges. This means that the fees for services are limited to a maximum of 80 percent of the UPMC charges.
While UPMC’s Financial Assistance Program covers most services, there are some exclusions, such as, but not limited to, cosmetic surgery, transplant- and bariatric-related services, elective reproductive services, acupuncture, private duty nursing, dental, and services deemed non-covered by Medicare.”

UPMC currently approves financial assistance for 6 months at a time, which they reduced recently from 1 year. Also, each individual service will be evaluated for its degree of medical necessity before payment, regardless of financial assistance approval status.

 http://www.upmc.com/aboutupmc/CommunityCitizenship/FinancialAssistance/Pages/fa-policy.aspx

WEST PENN ALLEGHENY CHARITY CARE

1-800-547-0540

The  Pennsylvania Health Law Project (www.phlp.org) shared information in their September 2010 newsletter on recent changes to both state and federal charity care laws that make hospital financial assistance policies more consumer-friendly. Hospitals are still not required to set specific eligibility levels for charity care (e.g., an income limit of 200% Federal Poverty Level), which means that eligibility remains a confusing issue for consumers. The new standards nonetheless make the process more transparent than before, and they may prevent some inappropriate collections actions. Just requiring hospitals to post notices that charity care exists could make a huge difference in people’s lives. 

Hospitals are now required to: 

• Post notices, in plain language, about the availability of charity care in multiple places in the hospital, on discharge paperwork and bills, and on their websites;

• Provide detailed information about charity care to patients upon request;

• Make eligibility decisions using only the information collected in the bulletin’s model application (or less);

• Make eligibility decisions without considering available credit, credit score, or non-liquid assets, such as a person’s house, vehicle, and retirement accounts;

• Help patients apply for Medical Assistance and have the appropriate doctor’s forms completed;

• Help patients apply for charity care; and

• Refrain from pursuing collections on unpaid bills until after helping patients apply for MA and charity care. 

Patients and consumer advocates who find a hospital that is not complying with these rules are encouraged to report this to DPW’s Bureau of Program Integrity at 1-866-DPW-TIPS. Individuals with charity care problems can also call PHLP’s Helpline at 1-800-274-3258.

More information here:

 http://www.phlp.org/Website/PHLP%20NEWS/2010.09%20PHLN-Final.pdf