Financial Assistance Policy 

Policy:
This policy is established to define those patients who are eligible for free care for non-elective services as well as to define those patients who are eligible for discounts under a sliding fee schedule. This policy applies to both insured patients as well as uninsured patients provided the patient meets the eligibility criteria defined below.

Who qualifies?
Sky Lakes Medical Center will provide non-elective services to patients whose household income falls at or below 200% of the Federal Poverty Level at no cost. For those patients who fall between 200% and 225% of the Federal Poverty Level and who are unable to pay their bills, patients are eligible for either a partial write-off of their account, annual maximum out of pocket, or both.

The Federal Poverty Level guidelines, published annually, will be used to determine eligibility.

This policy applies to both insured patients as well as uninsured patients provided the patient meets the eligibility criteria defined below.

If your income falls below 100% of the federal poverty level, you may be eligible for assistance through the Oregon Health Plan. Assistance through federal and state funding sources shall be pursued prior to application of this financial assistance policy. If you feel you may be eligible for the Oregon Health Plan, please contact Adult and Family Services (700 Klamath Ave. downtown) directly at 274-5511 or you may call our Patient Financial Services Office for assistance at 274-6221.

What services are discounted?
Only non-elective services are eligible for discounts under this financial asssistance policy. Under no circumstances are elective procedures covered under this policy. Eligible services are defined as all non-elective hospital and Cascades East Family Practice Clinic services. Excluded services are all elective procedures, walk-in pharmacy, physician services, and services required as a result of the patient's criminal behavior. Covered and non-covered services, as defined by a patient's insurance policy, will be considered eligible. Elective services are defined as gastric bypass surgery and other cosmetic procedures.

For physician services not provided at Cascades East Family Practice Clinic, see your physician regarding the availability of payment terms and/or discounts. Please let us know if you would like a copy of your approved financial assistance application. The approved application may be helpful to you in requesting assistance from other providers in the community.

It is the responsibility of the patient to notify Patient Financial Services at 274-6221 of the accounts that he/she wants included in the financial asssitance write-off consideration.

What discount levels are offered?
See the appendix to this policy for the income levels and corresponding discounts available. The discounts referenced apply only to the portion of the bill for which the patient is responsible.

Documentation Required
To verify your eligibility for assistance under this policy, you are required to provide your past two years tax returns, 3 months worth of pay stubs, and 3 months of the most recent bank statements.

Time Limits for Financial Assistance Applications
Application for assistance must be made no later than 120 days from the date of service or discharge. Please notify Patient Financial Services as soon as you are aware that you need assistance so that we can resolve your health care bills as quickly as possible. You will be notified in writing within 7 business days of the determination regarding your eligibility.

While application is required no later than 90 days after the first statement date, payment from all other sources must be received and the patient must have been denied Medicaid or otherwise be known to not quality for Medicaid before this financial asssitance policy will be applied to an account. If it is determined that you are eligible for Medicaid but you receive a denial for non-payment of premiums, you are not eligible for coverage under this policy.

Period of Time to Which Each Financial Assistance Application Applies
Each application will be effective for three calendar months. (The month in which application was made will be counted as month one.) Should the patient have services later in the same three month period, no further application need be made, however, the patient must notify a Patient Account Representative in Patient Financial Services that he/she desires the additional services to be included under the original financial assistance application.

Who Benefits?
Assistance under this policy is intended solely for the benefit of the patient and his or her family and does not relieve third parties of liability for payment.

Questions regarding this policy
If you have questions regarding your eligibility under this policy, eligible services, or the level of discount, please contact Patient Financial Services at 274-6221.

The Financial Assistance application is available as a PDF file.