• The Financial Hardship Policy is based on a locally determined discounted/sliding fee schedule, which is determined in part by formulas based on the U.S. Federal Poverty Guidelines, as published and updated periodically in the Federal Register.
• The discounted/sliding fee schedule applies only to amounts assessed to the patient – and not to any amounts covered by third-party carriers.
• The content and implementation of this policy is non-discriminatory and uniformly applied to all persons seeking medical services at Field Memorial Community Hospital and Clinics.

GOAL:

The goal of the Financial Hardship Policy is ensure that no eligible person will be excluded from receiving medical services at the Hospital and/or Clinics on the grounds that such a person may not have adequate resources to pay for those services.

The success of this policy is dependent upon three factors:

1. Having a clear distinction between “financial hardship” (for whom this policy is intended) and “bad debt”
2. Defining clearly which patients are eligible for a reduced rate or write-off
3. Providing a consistent, structured, non-discriminatory procedure for Hospital and Clinic personnel to follow in the certification process

DEFINITIONS:

• Financial hardship – “Inability” to pay the entire account, or the balance of an account, not paid by insurance

• Bad debt – “Unwillingness” to pay the account in question


PATIENTS WHO ARE ELIGIBLE:

1. Private pay (no insurance of any kind)

2. Residents of Amite or Wilkinson Counties

PATIENTS WHO ARE CERTIFIED:

1. Those who submit an application and is approved by Field Memorial Community Hospital and Clinics.

COVERD SERVICES:

1. Clinic primary care not to exclude medically necessary ancillary services
2. Hospital inpatient services
3. Hospital outpatient services pending prior approval (see number 2, B through D below)
4. Hospital ER services
5. Supplies and/or equipment that is medically necessary to provide stated services listed in 1 though 4 above

** Durable medical equipment and/or supplies will not be covered under this policy. All patients needing such supplies will be referred to a local DME supplier/vendor.

PERIOD OF CERTIFICATION:

1. One (1) year from date of approval for clinic services
2. Hospital Services:
A. Per Inpatient admission
B. Outpatient Surgical Services require pre-certification and re-evaluation (if already certified) to determine Medical Necessity and evaluation of current financial circumstances
C. Routine outpatient ancillary services (i.e. lab, x-ray, diabetic education, etc) CAN be evaluated every 90 days for appropriateness and qualification
D. Outpatient Rehab services require pre-certification and evaluation for medical necessity prior to initiation of therapy AND a re-evaluation of continued therapy every 7 days.

CERTIFICATION PROCEDURE:

• Field Memorial Community Hospital and Clinics will make this policy known to all eligible patients before any medical services are provided.

1. A sign, notifying patients of the opportunity to apply for coverage under the Financial Assistance Policy will be posted in a conspicuous and appropriate location in the Hospital and Clinics.
2. Appropriate personnel in the Hospital and Clinics should ask patients prior to services being rendered if they are aware of the Financial Assistance Policy, and if they wish to apply for coverage under that policy.

• On the date that an eligible patient is informed of the Policy, no charge will be assessed to that patient for that office visit in a Clinic – if the patient claims to be eligible, believes he/she would be certified for this policy, and agrees to submit an application for approval. However, all future visits will be subject to normal charges until the application is approved.

• To become certified, a patient must submit an official FMCH Financial Hardship Application, which must then be approved by Field Memorial Community Hospital and Clinics.

• Before approving the FMCH Financial Hardship Application, Field Memorial Community Hospital and Clinics will investigate and inquire as to the accuracy of all information documented in the application – in order to make a determination as to the patient’s ability to pay and thus the level of Financial Hardship Policy (FHP) discount that will be afforded to future services.

• Upon approval of the application, the patient is certified under the Financial Hardship Policy for a specific FHP discount for the period of certification established in the most currently issued policy statement.