It is the policy of weh to provide financial assistance in the form of financial assistance and partial financial assistance from weh to patients residing in the state of pennsylvania and does not include non-employee physicians or other services provided by outside providers.
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Patients seeking emergency care at WEH will be treated without regard to their ability to pay for such care. weh operates in accordance with all federal and state requirements for the provision of health services as required by the federal emergency medical treatment and active work act (emtla).
In keeping with the mission of Weh Eye Hospital (WEH) to provide care to the needy and underserved in a manner that preserves the dignity of the individual, this Financial Assistance Policy (the Policy) describes the policies and procedures related to with the provision of assistance to people who cannot pay all or part of their bill. no person will be denied medically necessary non-elective services based on a demonstrated inability to pay for those services.
patient care manual 220.127.116.11 patient health records
leadership manual 18.104.22.168 records retention and destruction
financial assistance: 100% free healthcare for medically necessary services provided by weh. patients who are uninsured or underinsured for a medically necessary service, who are not eligible for government or other insurance coverage, and who have family income that does not exceed 200% of the federal poverty guidelines are eligible to receive financial assistance. (see attachment 2).
medical necessity: any diagnostic study, procedure or treatment necessary to prevent, diagnose, correct, cure, alleviate or prevent the worsening of conditions that endanger life, cause suffering or pain, result in sickness or disease, threaten to cause or aggravate disability, or cause physical deformity or malfunction, if no other equally effective, more conservative, or less expensive course of treatment is available.
partial financial assistance: care at a discounted rate for medically necessary services provided by weh. Patients who are uninsured or underinsured for a medically necessary service, and who have family income greater than 200%, but not greater than 500%, of the Federal Poverty Guidelines are eligible for partial financial assistance at form of a sliding scale discount off charges. (see annex 3). however, patients who would otherwise qualify for partial financial assistance but have sufficient available liquid assets to pay for care without becoming medically indigent are not eligible for partial financial assistance.
uninsured patient: a person who does not have any third-party health care coverage from: (a) a third-party insurer, (b) an erisa plan, (c) a federal health insurance program (including, but not limited to, medicare, medicaid, healthchoices, chip, adult basic, and tricare), (d) workers’ compensation, (e) health care reinsurance or savings accounts, or (f) other coverage, for any part of the bill, including claims against third parties covered by insurance to which we are subrogated, but only if payment is actually made by that insurance company.
underinsured patient: a person who has limited health insurance coverage in the scope of covered services or policy maximums, such that their medical bills are not fully covered .
1. identify patients eligible for financial assistance or partial financial assistance
1.1. patients who qualify for financial assistance or partial financial assistance should be identified as early as possible, either before or after care is provided.
1.2. If it is difficult to determine a patient’s eligibility prior to the provision of care, such determination will be made as soon as possible, but no later than 6 months after the provision of care.
1.3. We will post and post signs and notices on the internet to inform patients of the availability of financial assistance and partial financial assistance in the English and Spanish languages.
2. dissemination of eligibility information
2.1. Patients identified through the registration process who appear to be uninsured or underinsured and who indicate their inability to pay for medically necessary services will receive:
2.1.1. an information packet that describes this financial assistance policy and the relevant procedures, including a financial assistance application and/or,
2.1.2. financial advice, including an application for financial assistance.
2.2. To enable WEH to properly determine financial assistance or partial financial assistance eligibility, documents provided to patients by WEH must be written in English and translation assistance will be provided as needed.
3. eligibility methodology
3.1. weh will adhere to an established methodology to determine eligibility for financial assistance and partial financial assistance. the methodology should consider whether the health care services meet the medical necessity criteria, as well as income, family size, and resources available to pay for care.
3.2. all available financial resources will be evaluated prior to making a determination regarding financial assistance or partial financial assistance. We will consider the patient’s financial resources, as well as those of others who have a legal responsibility to provide for the patient (eg, parent of a minor, spouse).
3.3. patient/guarantor will need to provide copies of documents to substantiate income levels and assets (eg, w-2s, tax returns, pay stubs, bank statements)
3.4. The patient/guarantor will be required to provide sufficient information for us to determine if he or she is eligible for benefits available from insurance, Medicare, Medicaid, workers’ compensation, third-party liability, and other federal, state, or local programs.
3.4.1. If in the course of evaluating the patient’s financial circumstances it is determined that the patient may qualify for federal, state, or local programs or insurance coverage, information will be provided to assist patients in applying for available coverage. Patients/Guarantors who do not fully cooperate in applying for available coverage will be denied Financial Assistance and Partial Financial Assistance.
3.4.2. patients with health care reinsurance or health savings accounts are insured for purposes of this policy, and the amount deposited will be considered an available resource for payment of medically necessary services.
3.4.3. If a patient has a claim (or potential claim) against a third party where the hospital bill may be paid, the hospital will defer its financial assistance determination until the third party claim is resolved.
3.5. eligibility for financial assistance or partial financial assistance will be determined using a sliding scale based on 200-500% of the federal poverty level guidelines as published annually in the federal register, as well as consideration of available assets and any circumstances extenuating. (see attachment 3)
3.6. Eligibility for financial assistance and partial financial assistance will be extended up to 180 days from the date eligibility is determined.
3.7. patients/guarantors will be notified in writing when we make a determination regarding financial assistance or partial financial assistance.
3.8. this policy covers the weh surgery center, weh clinics and the emergency room. services provided by doctors and other non-medical services are not covered by this policy. patients seeking a discount for such services should contact the physician or other provider directly.
3.9. All information obtained from patients and guarantors will be treated as confidential to the extent required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
3.10. this policy is subject to change without notice, is subject to interpretation by weh in its sole discretion, and is not intended to create any contractual relationship or obligation.
Annex 1: proof of income and residence. click here.
Appendix 2: Federal Poverty Guidelines. click here.
Annex 3: financial assistance and partial financial assistance. click here.
annex 4: discount information for prompt payment. click here.
Annex 5: patient billing and collection. click here.
documentation required from the patient assistance program