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Financial Assistance Policy

I. Objective

Consistent with its mission to provide high quality health and wellness services for the community, Augusta Health is committed to providing free or discounted care to individuals who are in need of emergency or medically necessary treatment and have a household income below 400% of the Federal Poverty Level (FPL) Guidelines.

In accordance with the federal Patient Protection and Affordable Care Act (PPACA) and section 501(r) of the Internal Revenue Service code, all other uninsured patients will not be charged more than the amount generally billed to insured patients for emergency or medically necessary care.

II. Policy

Free care is provided only when care is deemed medically necessary and after uninsured (or underinsured) financial assistance eligible patients have been found to meet all qualifying criteria.

Patients seeking financial assistance may be assisted with applications for other means of payment (e.g., Medicaid, other local funding programs) BEFORE approval for financial assistance.

Uninsured patients who do not qualify for Augusta Health's financial assistance program (e.g., due to their household income) will receive a discount of 50% on gross charges for medically necessary services to ensure they do not pay more for care than insured individuals. These patients are expected to pay their remaining balance for care, and may work with financial counselors to set up a payment plan based on their financial situation.

Uninsured patients who are believed to have the financial ability to purchase health insurance may be encouraged to do so in order to ensure healthcare accessibility and overall well-being. Augusta Health is equipped with financial counselors to assist in this process.

III. Definitions

The following terms are meant to be interpreted as follows within this policy:

  1. Financial assistance: Healthcare services provided which are not expected to result in cash inflows; medically necessary services rendered without expected payment to individuals meeting established criteria.
  2. Medically Necessary: Hospital services or care rendered to a patient, both inpatient and outpatient, in order to diagnose, alleviate, correct, cure, or prevent the onset or worsening of conditions that endanger life, cause suffering or pain, cause physical deformity of malfunction, threaten to cause or aggravate a handicap, or result in overall illness or infirmity.
  3. Emergency Care: Immediate care which is necessary to prevent serious jeopardy to a patient's health; serious impairment to bodily functions, and/or serious dysfunction of any organs or body parts.
  4. Urgent Care: Services necessary in order to avoid the onset of illness or injury, disability, death, or serious impairment or dysfunction if not treated within 12 hours.
  5. Uninsured: Patients with no insurance or third-party assistance to help resolve their financial liability to healthcare providers.
  6. Underinsured: Patients who have limited healthcare coverage, or coverage that leaves the patient with an out of pocket liability, and therefore may still require financial assistance.
  7. Catastrophic Charity: Financial assistance given to patients whose medical expenses exceed one-fourth of their total household income.

IV. Procedures

(A) Eligibility for Financial Assistance

Augusta Health patients who are deemed financial assistance eligible will not be charge more than amounts generally billed to insured patients for emergency or medically necessary care.

Services eligible for financial assistance include: emergent or urgent care, services deemed medically necessary by Augusta Health, and in general, care that is non-elective and needed in order to prevent death or adverse effects to the patient's health.

Patients who have a household income below 200% of the Federal Poverty Level (shown in the table below) may receive free care. Patients who have a household income from 200% to 400% of the Federal Poverty Level may qualify for a reduction of 50% to 90% of total charges.

2018 Federal Poverty Level Guidelines

Family Size 12 Month Income
1 $12,140
2 $16,460
3 $20,780
4 $25,100
5 $29,420
6 $33,740
7 $38,060
8* $42,380

*If there are more than eight individuals in the family, add $4,320 for each additional member.

The chart below calculates the discount patients can expect based on the household income:

Household
Members
2018 Federal Poverty Level Annual household income to receive discounted care
100% Discount 90% Discount 80% Discount 70% Discount 60% Discount 50% Discount
1 $12,140 <$24,280 $24,281 - 29,136 $29,137 - 33,992 $33,993 - 38,848 $38,849 - 43,704 $43,705 - 48,560
2 $16,460 <$32,920 $32,921 - 39,504 $39,505 - 46,088 $46,089 - 52,672 $52,673 - 59,256 $59,257 - 65,840
3 $20,780 <$41,560 $41,561 - 49,872 $49,873 - 58,184 $58,185 - 66,496 $66,497 - 74,808 $74,809 - 83,120
4 $25,100 <$50,200 $50,201 - 60,240 $60,241 - 70,280 $70,281 - 80,320 $80,321 - 90,360 $90,361 - 100,400
5 $29,420 <$58,840 $58,841 - 70,608 $70,609 - 82,376 $82,377 - 94,144 $94,145 - 105,912 $105,913 - 117,680
6 $33,740 <$67,480 $67,481 - 80,976 $80,977 - 94,472 $94,473 - 107,968 $107,969 - 121,464 $121,465 - 134,960
7 $38,060 <$76,120 $76,121 - 91,344 $91,345 - 106,568 $106,569 - 121,792 $121,793 - 137,016 $137,017 - 152,240
8 $42,380 <$84,760 $84,761 - 101,712 $101,713 - 118,664 $118,665 - 135,616 $135,617 - 152,568 $152,569 - 169,520

Uninsured patients who do not meet these income requirements will receive a discount of 50% on gross charges for medically necessary and emergency care that they receive.

  • Example #1: An uninsured patient who does not qualify for financial assistance
Total charges $100.00
Uninsured adjustment $ 50.00
Total balance due $ 50.00
  • Example #2: A patient who qualifies for 100% financial assistance
Total charges $100.00
Financial assistance adjustment $ 100.00
Total balance due $ 0.00
  • Example #3: A patient who qualifies for 50% financial assistance:
Total charges $100.00
50% Financial assistance adjustment $ 50.00
Total balance due $ 50.00

Determinations for eligibility for free care will require patients to submit a complete financial assistance application (including all documentation required by the application) and may require appointments or discussion with hospital financial counselors.

When determining patient eligibility, Augusta Health does not take into account race, gender, age, sexual orientation, religious affiliation, social or immigrant status, or age of the patient's account.

Additionally, Augusta Health may refer to or rely on external sources and/or other program enrollment resources if uninsured patients lack documentation that supports eligibility. For example, Augusta Health may provide free care when:

  • Patient is homeless
  • Patient is eligible for other state or local assistance programs that are unfunded
  • Patient is eligible for food stamps or subsidized school lunch program
  • Patient is eligible for a state-funded prescription medication program
  • Patient's valid address is considered low-income or subsidized housing
  • Patient receives free care from a community clinic and is referred to hospital for further treatment

(B) Determining the Financial Assistance Adjustment

Individuals eligible for financial assistance under this policy shall not be charged more than the amounts generally billed (AGB) to individuals who have insurance. This value shall be calculated using the "look-back" method based on actual paid claims from Medicare fee-for-service and private health insurers. The current AGB is 50% and is updated annually.

(C) Catastrophic Charity Eligibility

Individuals whose household income exceeds 400% of the federal poverty guidelines, and have a catastrophic illness resulting in expenses that are greater than one-fourth of their annual income, may receive a catastrophic charity adjustment.

(D) Applying for Financial Assistance

To apply for financial assistance, patients must submit a complete application (including supporting documents) to Augusta Health Business Office, P.O. Box 1000, Fishersville, VA 22939 either in person or by mail.

Applications can be accessed:

  • At the facility at all registration and access points on the main hospital campus, at all Augusta Medical Group physician offices, as well as at the Business Office.
  • By mail, if individuals make a request by phone (call (540) 332-4600) or by mail (send request to P O Box 1000, Fishersville, VA 22939)
  • Online at https://www.augustahealth.com/business-office/financial-assistance.

To be considered eligible for financial assistance, patients must cooperate with the hospital to explore alternative means of assistance if necessary, including Medicare and Medicaid. Patients will be required to provide necessary information and documentation when applying for hospital financial assistance or other private or public payment programs.

In addition to completing an application, individuals should be prepared to supply the following documentation:

  • Bank statements
  • Proof of income for applicant (and spouse if applicable), such as recent pay stubs (3 months' worth), unemployment insurance payment stubs, or sufficient information on how patients are currently supporting themselves
  • Copy of most recent tax return
  • Payment history of any outstanding accounts for prior hospital services
  • In some cases, information on available assets or other financial resources

External – public sources such as credit scores may also be used to verify eligibility.

Financial counselors are available to assist in the application process in person at 189 Medical Center Circle, Fishersville, VA 22939 from 8:00am – 4:30pm, Monday through Friday, or by phone at (540) 332-4600.

Representatives at several community agencies are also able to assist with completing Augusta Health's financial assistance applications, and their contact information is as follows:

  • Alltran Health, Inc.
    78 Medical Center Drive
    Fishersville, VA 22939
    (540) 332-4619
  • Augusta Regional Clinic/Augusta Free Clinic
    342 Mule Academy Road
    Fishersville, VA 22939
    (540) 221-6123

*Note: Augusta Health has access to translators who can assist patients who are unable to speak English.

(E) Actions in the Event of Non-Payment

The collection actions Augusta Health may take if a financial assistance application and/or payment is/are not received are described in a separate billing and collections policy.

In brief, Augusta Health will make certain efforts to provide uninsured patients with information about our financial assistance policy, such as including a summary of it with billing statements, before we or our collection vendors take certain actions to collect your bill (these actions may include charging of interest, some civil actions, or reporting of outstanding debt to credit bureaus).

For more information on the steps Augusta Health will take to inform uninsured patients of our financial assistance policy and the collection activities we may pursue, please see Augusta Health's billing and collections policy.You can request a free copy of this policy at The Business Office at Augusta Health located at 189 Medical Center Circle, Fishersville, VA 22939 or request a free copy by mail by calling ((540) 332-4600 or mailing a request to Augusta Health Business Office, P.O. Box 1000, Fishersville, VA 22939 or access it free of charge online here: https://www.augustahealth.com/business-office/financial-assistance.

(F) Communication of Financial Assistance

Augusta Health's financial assistance policy, financial assistance application, and summary of the financial assistance policy are available to patients in English and Spanish.

These documents are available free of charge at our facility, by mail, and online.

  • To access any of these documents at the facility, please see visit the Business Office at 189 Medical Center Circle in Fishersville, VA 22939.
  • To have a hard copy of any of these documents mailed to you, please call (540) 332-4600 or mail a request to Augusta Health Business Office, P.O. Box 1000, Fishersville, VA 22939
  • To access the Financial Assistance Policy, the summary of the Financial Assistance Policy, or the Financial Assistance Application, please use the following web address:
  • https://www.augustahealth.com/business-office/financial-assistance

Augusta Health communicates the availability of financial assistance through means which include:

  • Posting signs within waiting rooms, registration kiosks, and check-in desks, as well as emergency rooms, urgent care centers, and financial services departments
  • Providing brochures in waiting rooms and registration areas in the emergency department, urgent care, outpatient areas, and inpatient areas
  • Creating a document that summarizes the financial assistance policy, which is given to patients by hospital team members at discharge and sent with patient statements
  • Ensuring free copies of financial assistance documents (policy, application, and summary) can be obtained within the facility and by mail
  • Posting information about financial assistance (including summary, application, and policy) on Augusta Health's website
  • Providing information about the policy and how to apply during verbal communication about the patient's bill (e.g., phone calls)
  • Ensuring designated staff are knowledgeable of the financial assistance policy and can answer patients' questions or refer patients to the program
  • Notifying local physician practices and representatives of community and social service agencies, including Augusta Medical Group, and other non-affiliated community physician offices about the availability of financial assistance at Augusta Health and how interested individuals can apply
  • Providing brochures and copies of the summary of our assistance policy to local physician offices and community agencies, including all Augusta Medical Group offices
  • Inclusion of the financial assistance application with billing statement for uninsured and underinsured patients.

(G) Ensuring Compliance

On an annual basis, the Director of Patient Accounting or designee and/or the Director of Finance or designee, will perform an audit to include:

  • a random sampling of billing statements to ensure it includes all information required,
  • a visit to each physician office and registration point within the hospital to ensure each point of entry has access to the updated financial assistance policy, as well as updated financial assistance applications and staff are informed on how to inform patients of each,
  • an audit of the website to ensure the application and policy are still easily accessible,
  • and a look-back to ensure the then reimbursement rates of the payers being used to calculate an average of "amounts generally billed" does not fall below that of what a patient who qualifies for financial assistance is being billed.

Patients concerned about their ability to pay for services or who would like to learn more about financial assistance should be directed to the Patient Financial Services Department at (540) 332-4600.

Appendix A: "Plan Language Summary"

In accordance of the 501 (r) charity requirements, below is considered the "Plan Language Summary" of the Augusta Health Financial Assistance Policy which will accompany all billing statements and be presented to patients during all financial discussions.

Consistent with its mission to provide high quality health and wellness services for the community, Augusta Health is committed to providing free or discounted care to individuals who are in need of emergency or medically necessary treatment and have a household income below 400% of the Federal Poverty Level (FPL) Guidelines. Individuals who qualify for financial assistance will not be charged more than the average amounts generally billed to insured patients, for emergency or medically necessary care.

Financial counselors are available Monday through Friday, from 8:00am until 4:30pm to discuss the application process at ((540) 332-4600.

Augusta Health will not pursue extraordinary collections actions against an individual without first using reasonable efforts to determine if such individual is eligible for financial assistance.

For a free copy of the entire Financial Assistance Policy and/or an Application for Financial Assistance in English or Spanish, patients can:

Appendix B: Financial Assistance Application

Download the Financial Assistance Application (Spanish)