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Providence Health System California Region Administrative Policies
Charitable Services Policy
Effective Date: 06/01/2006
Supercedes: 03/01/2006
Supercedes: SFVSA FIN 14/LCMSA
POLICY:
It is the policy of the Providence Health System, California Region, in response
to its philosophy and mission, to provide services for all persons, regardless of
age, sex, race, religion, origin or ability to pay. By identifying an inability to
pay, Providence Health System, California Region, will assist patients in resolving
their debts for health care and to provide financial peace of mind for eligible
patients. An inability to pay can be identified at any time during the revenue
cycle, from admission up to the point where legal action, as requested by an outside
collection agency, is authorized.
American Hospital Association, California Hospital Association, the California
Alliance of Catholic Healthcare, and Providence Health System’s Commitment to
the Uninsured Guidelines are incorporated into Providence Health System-California
Region Financial policies and are attached for reference.
PURPOSE:
To identify patients with an inability to pay.
DEFINITIONS:
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1.
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Charitable services shall include all services received by private pay patients,
and shall include co-payment liabilities, as determined by third party payers, in
which it is determined that the patient is financially unable to pay. Charitable
services are provided to all eligible patients receiving emergency care. In certain
instances, patients and their physicians may seek charitable services for elective,
deferrable care. In those instances, certain requirements must be met:
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a.
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the charitable services request must be submitted by a member of the medical staff
of a PHSSC facility.
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b.
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the patient is ALREADY a patient of the requesting physician and the care is needed
for good continuity of care; cosmetic procedures are not eligible for charitable
services.
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c.
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the physician will provide services without compensation.
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d.
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the patient lives within our service area.
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e.
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the patient completes a charitable services application and receives approval prior
to receiving the elective care.
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2.
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Inability to pay is defined in this policy as:
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a.
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Patients unable to provide a residence address (homeless).
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b.
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Non covered services rendered to patients who are enrolled in some form of Medi-Cal
or State Indigency Program and who receive services not covered by that program
(for instance, receiving services outside of restricted Medi-Cal coverage), or
services denied Medi-Cal treatment authorization, as financial qualification for
these programs includes having no more than marginal assets and a Medi-Cal defined
share of cost as the maximum ability to pay (the share of cost is expected to be
paid; however the patient could submit a charitable application to demonstrate an
inability to pay even that portion).
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c.
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A patient’s inability to pay is identified via an outside collection agency
income/asset search in preparation for a lawsuit request. Should the agency determine
that a lawsuit will not be pursued, the account will be placed in an inactive status,
where a monthly review will determine further action.
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