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Providence Health System California Region Administrative Policies
Private Pay Discounting
Effective Date: 03/01/2006
Supercedes: August 1, 2004
POLICY:
It is the policy of Providence Health System, California Region (PHSCA), in response
to its philosophy and mission, to charge all patients an equitable amount for health
care services provided. For patients covered by government programs, managed health
care plans, or other third party payers, the rates charged for services are determined
by governmental policy or negotiated contracts. For those patients not covered by a
third party payer, the hospital’s retail billed charges will be discounted. This
policy does not apply to physician billings.
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 establish fair and equitable rates for all services payable by patients without
access to a third party payer resource for health care.
DEFINITIONS:
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1.
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Private pay patient: a patient, whether able to pay for health care or one who
cannot afford the cost of healthcare, who is not covered by any third party payer,
or whose service is not a covered benefit of a health plan.
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2.
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A private pay patient is NOT a patient who must pay the full cost of a particular
health care billing because the third party payer applied the entire allowable amount
toward a patient co-payment liability or annual deductible. Any patient co-payment
amount is expected to be paid in full, unless the patient can demonstrate financial
hardship according to the requirements of the Regional Charitable Services Policy
(Regional Financial Policy XX-XX).
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3.
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Equitable amount for private patients means the discount arrangements as established
in ADDENDUM #1.
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4.
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Medical Savings Accounts: we will accept a payment from a Medical Savings Account Fund
Administrator at these discounted levels, absent a managed care contract with specified
contract rates.
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5.
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Prompt payment discount: a private pay patient who pays in full at time of service will
receive an additional discount.
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6.
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Excluded entities: Del Amo Diagnostic Center, St. Elizabeth’s Convalescent Center,
and Long Term Care patients at Little Company of Mary – San Pedro Pavilion. Existing
prompt payment arrangements will continue for those three entities.
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