Patient Financial Hardship

Objective

To provide an appropriate basis and method to reduce fees for patients who are uninsured or unable to afford CUIMC professional services.

Policy

  • CUIMC clinicians strive to provide the highest standard of professional services to patients without regard to their ability to pay.
  • If patients are eligible for Medicaid benefits, departmental staff should help them in the Medicaid enrollment process or direct them to others who can assist them.
  • Where patients (a) are unable to pay for services based upon financial need, such as no insurance coverage, income three times the Federal Poverty Level or less, or other financial hardship such as recent high medical bills for the patient or a dependent; and (b) are not eligible for Medicare or Medicaid, they should be offered an opportunity to pay lower fees or no fees for services based upon a pre-established sliding scale for professional fees.
  • To qualify for reduced or no fees, the patient must provide the department with written evidence of income and/or other financial hardships. Sources of verification of income include tax returns, paycheck stubs, and W-9 statements. Sources of verification of other financial hardships include official physician bills and explanations of benefits (“EOBs”). High medical expenses or other financial hardship may also be documented by patient interviews and questionnaires. In this instance, the department may wish to obtain a current utility bill or other form of reliable documentation from the patient to verify the patient’s name and residence.
  • The patient’s ability to pay and the number of services that may be covered by the sliding scale may be determined for each episode of care, or for a predetermined number of services.
  • This policy must be applied in a uniform manner to all patients that request accommodation based on financial hardship; if the department utilizes the sliding scale for fees for some patients that request accommodation, it must do so for all qualified patients requesting accommodation. Consult your departmental administrators or the Clinical Revenue Office with any questions.
  • This policy does not permit waivers of co-payments or deductibles for insured individuals and does not extend to issues of bad debt or contractual adjustments based on managed care fee for service or unrelated administrative adjustments for individual circumstances.
     

 

 

 

Office for Billing Compliance
Policy#: 10036
Original Date of Issue: 1996
Revised: 3/22/2023
Reviewed: 3/1/2024