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Warren General Hospital maintains a program to provide free or discounted medical services to qualifying individuals. Free and discounted care constitutes “Financial Assistance.”
This policy outlines the circumstances under which Financial Assistance discounts may be provided to qualifying low income patients for all emergency and medically necessary healthcare services, as determined by the examining physician of Warren General Hospital.
In order to make the best use of available resources, Warren General Hospital requires that patients/families attempt to obtain any assistance potentially available from government and non-government assistance programs, including:
• The Children’s Health Insurance Program (CHIP), and
• Publically supported Insurance Exchange Products.
Financial assistance is secondary to all other financial resources available to the patient.
Discounted care is available to individuals whose household income is less than 300% of the Federal Government Poverty Income Guidelines. The level of discount will be based upon the individual’s income, financial resources, and household size. Free care is available to individuals whose household income is less than 200% of the Federal Government Poverty Income Guidelines.
Individuals may request an application within 120 days of the date of the first bill. Any employee or physician may refer an individual to the financial counselor for assistance in determining eligibility.
Individuals who desire to obtain financial assistance must complete the Hospital’s Financial Assistance Application and provide all requested documentation of assets.
Individuals also must make timely application for the Medical Assistance Program as a condition of obtaining free or discounted care. The financial counselor or the Patients Accounts Manager will review the application and make a determination as to eligibility and the amount of free of discounted care. The individual will be notified of the determination of eligibility within 30 days of submitting a complete application.
Warren General Hospital determines the basis for calculating amounts charged to patients by using the Look Back Method. Once per year, The Hospital calculates the Amount Generally Billed (AGB) percentage by Medicare fee-for-service. The AGB percentage is applied to gross charges for services provided to the patient. The patient will be required to pay the lesser of the AGB percentage of gross charges or the financial aid percentage of gross charges as determined by the financial counsellor.
WGH reserves the discretion to take any lawful measures to collect the debt, including the use of third-party collections agencies, reporting debts to credit agencies, and obtaining a lien or judgment on the individual’s property if an individual does not pay (or set up a payment plan for) an outstanding balance.
If a patient fails to pay the self- pay portion of discounted care invoices the patient will be disqualified from receiving future financial assistance until the outstanding delinquency is paid in full.
WGH will maintain documentation of each individual’s application for the financial assistance program and the amount of financial assistance the applicant received. The Hospital will review an individual’s prior Financial Assistance eligibility but will not use prior eligibility to presumptively determine continued and ongoing eligibility.
Warren General Hospital Category: Patients’ Rights
Warren, Pennsylvania Number: 101.02
Title: Financial Assistance Program Revision: 8