FINANCIAL ASSISTANCE

WHAT IS THE HOSPITAL CARE PAYMENT ASSISTANCE PROGRAM?

Newton Medical Center’s Financial Assistance Program (Charity Care Assistance) is available to qualified individuals based on financial need who are uninsured or underinsured.  Financial assistance and reduced charge care are available only for necessary hospital care. Some services such as physician fees, anesthesiology fees, radiology interpretation, and outpatient prescriptions are separate from hospital charges and any charity assistance is determined by the provider of those services.

WHO IS ELIGIBLE FOR HOSPITAL CARE PAYMENT ASSISTANCE?

Financial Assistance is available to Newton County residents who:

1. Have no health coverage or have coverage that pays only for part of the bill
2. Are ineligible for any private or governmental sponsored coverage (such as Medicaid)
3. Meet both the income and assets eligibility criteria listed below.

Financial assistance is also available to non-county residents, subject to specific provisions.

Income Criteria

Criteria for eligibility is annual household income as a percentage of HHS Poverty Income Guidelines.

Annualized household income:                                                            Percentage of                                                                                                                Charge Paid                                                                                                                  by Patient

Greater than 185%                                                                                               0%
Less than 185% but not greater than 165%                                                         10%
Less than 165% but not greater than 150%                                                        20%
Less than 150% but not greater than 140%                                                        40%
Less than 140% but not greater than 120%                                                        60%
Less than 120% but not greater than 100%                                                        80%
Income meets yearly published FPG                                                                 100%

Final determination of eligibility of any patient for Payment Assistance will be determined in the sole discretion of Hospital Management.

HOW ARE MY HOSPITAL CHARGES CALCULATED
           
All hospital charges are the same for all patients.  If you are approved for Financial Assistance, your financial responsibility, if any, will be calculated using the income criteria above based and our best estimate of the average payment the hospital receives from Medicare for inpatient services provided and our best estimate of average managed care payment for outpatient services provided.

WHAT ARE THE SCREENING PROCEDURES FOR THIRD PARTY PAYERS AND MEDICAID?

All Financial Assistance applicants must be screened for other potential payment sources prior to submitting an application for the program being deemed complete for consideration.  This screening will determine the potential eligibility for any third party insurance benefits or medical assistance programs that might pay all or some of the amount due the hospital.

Patients may not be eligible for the hospital financial assistance program until they are determined to be ineligible for any other medical assistance programs, at the discretion of hospital management.

Patients are responsible to obtain a financial screening from the hospital in a timely manner. Usually, a patient must apply for Medicaid within 3 months from the date of hospital services.

Once the hospital has informed the patient about medical assistance and/or makes the referral properly, if the patient fails to cooperate or does not go for screening in a timely manner, the hospital has the option to bill the patient and pursue collection efforts, regardless of eligibility for hospital care payment assistance.

To obtain a screening, please call our Human Services coordinator at 770.385.4409.

HOW DOES SOMEONE APPLY FOR HOSPITAL CARE PAYMENT ASSISTANCE?     

The patient must apply for financial assistance at the time of admission or within 90 days  after discharge.  If a prospective patient is seeking financial assistance for an upcoming procedure which he/she plans to obtain, the patient must be screened to determine if there are other sources that will potentially pay all or a significant portion of the patient’s bill.  If no payment source is determined, the patient’s application can be reviewed for Financial Assistance eligibility hospital management. Only fully completed applications will be considered.

The patient or responsible party must answer questions related to his/her income and assets, as well as provide documentation of the income and assets.

The hospital will make a determination of whether the patient is eligible as soon as possible, but no more than ten working days from the time a complete application is submitted. If the request does not include adequate documentation to make a determination, the request shall be denied and additional documentation needs identified for the patient to follow up upon. The patient will then be allowed to present additional documentation to the hospital. The applicant has up to 90 days from the date of service to apply for hospital assistance and provide the hospital with a completed application.

The completed application may also be used to determine eligibility for earlier unpaid debts at the discretion of management, but generally will not be used for debts greater than one year old.

Patients found ineligible may reapply at a future time when they present themselves for services and believe their financial circumstances have changed.

Newton Medical Center customer service representatives are available to assist with any questions or concerns. Please call the Patient Financial Services department at Newton Medical Center during business hours at 770.385.4101.