Fall River Health Services Financial Assistance Policy
At Fall River Health Services we strive to ensure the availability of healthcare in southwest South Dakota. Our goal is to meet the needs of people who need our care. FRHS has developed a policy for providing charitable services to those seeking assistance, regardless of their ability to pay.
Who is eligible for Financial Assistance?
Financial assistance eligibility is based on an individual's ability to pay and will not be denied because of race, color, religion, national origin, sex, disability or age. Please inquire at the Business Office for complete eligibility guidelines.
How do I apply?
Request a financial aid application from the Admissions Office located in the front entrance of the hospital.
Complete the application to the best of your ability. You can obtain assistance from the business office personnel in answering questions and assisting in the process.
The application process does include income verification and you will be requested to supply your most recent tax return and/or 3 months paycheck stubs/statements, or social security disability income letter. Once the application and financial information is received, it takes about 2-4 weeks after all documents are properly submitted to complete the review process. You will be notified promptly once a decision has been made or if additional information is needed.
Fall River Hospital is committed to protect your confidentiality through hospital policy. Any information you provide will not be shared with any other entity other than for the purpose of providing your healthcare. For more information, questions, or assistance regarding the Financial Assistance Program, contact 605-745-8910, extension 404.
Financial Assistance Policy:
To allow financial assistance to those patients for medically necessary services meeting the financial assistance criteria.
The following financial assistance policy is to make financial assistance available to financially eligible individuals, thus allowing all individuals access to medically necessary care at Fall River Health Services.
I. Financial Assistance Application Guidelines:
A. Patients who receive care at Fall River Health Services are generally expected to contribute to the cost of their care based on their ability to pay.
B. Financial assistance adjustments are available for medically necessary services.
Non-essential elective services (considered non-covered by Medicare or Medicaid) are not considered for financial assistance.
C. Patients with cash and non-cash equivalent assets in excess of $50,000 are not eligible for financial assistance.
D. Applicants need to be aware that falsifying information on the financial assistance application will be grounds for denying or revoking financial assistance. Falsifying an application includes, but is not limited to, failure to disclose assets, as well as transferring assets to avoid reporting them.
E. List of both covered and non-covered providers and services under the financial assistance program will be publicly available on the organizations website.
F. Applicants are required to complete and sign a financial assistance application. The application focuses on identifying the size of the family unit and financial information sufficient to determine if the applicant qualifies for financial assistance. The financial information required includes, but is not limited to, monthly income, as well as assets and liabilities.
G. Adult children older than 18 living with a parent cannot be claimed as dependents for calculating eligibility unless the adult child is disabled. To be able to claim the disabled adult child as a dependent, a copy of the adult child's SSI letter must be submitted with the financial assistance paperwork.
H. The applicant will be asked to provide proof of gross household income such as:
Last 2 pay stubs, Social Security Check copy, Income Tax Return, Letter from Social Security office, W-2 Form, and Other records documenting income.
I. Applicants are invited to submit any additional documentation they feel may be useful in the evaluation and determination process including information detailing permanent or severe illness, extenuating circumstances, and expenses such as prescription drugs, child care, alimony/child support.
J. If applicable, the patient's insurance is filed and payment is received from the insurance company before determining any financial assistance adjustment. Failure of an applicant to cooperate with claims filing, or collecting from a potential third party resource, will be grounds for denying financial assistance.
II. Financial Assistance Procedures:
A. A representative of Fall River Health Services counsels with self-pay patients to determine the level of financial need and to determine payment arrangement prior to services, if possible. If the patient's situation appears to meet the financial assistance guidelines, an application for financial assistance is initiated.
B. Physicians can help identify patients who may require financial assistance and refer the patients to an appropriate Fall River Health Services representative prior to scheduling or performing non-emergency services.
C. Since financial assistance is considered a resource of last resort, every attempt will be made to assist the patient in becoming covered under any available assistance programs, state, local, federal or community based, etc.
D. Financial assistance policy will be made available through request through the Business Office or can be access online through the company website.
E. When a financial assistance application is initiated, Fall River Health Services representative advises the applicant of the supporting documentation that is required before the financial assistance request will be considered.
F. Fall River Health Services representative follows up on incomplete financial assistance applications. If all supporting documentation is not submitted within 30 days of the application, the request for financial assistance is denied.
G. Once the necessary signatures are completed and approval or denial is confirmed, a Fall River Health Services representative sends the patient a letter informing them of the decision.
H. If the application is approved, the patient should agree to payment arrangements on the remaining balance of their account, if any, with a Fall River Health Services representative and/or appropriate collection agency.
I. Balances for those approved will not exceed the accepted Medicare rates.
III. Financial Assistance Standards:
To be considered for a financial assistance allowance, the following criteria must be met:
A. Generally, applications will not be accepted for accounts which have been turned over to a collection agency or written off as bad debt by the Fall River Health Services. However, this is a guideline which the Fall River Health Services Administrator can waive.
B. The Health and Human Services (HHS) Poverty Income Guideline (PIG) as published annually in the Federal Register will be the basis for guidelines used to qualify applicants. Based on gross income and family size, applicants will be eligible for financial assistance as follows:
0-100% HHS PIG Base = 100% write off
101-115% HHS PIG Base = 75% write off
116-130% HHS PIG Base = 50% write off
131-145% HHS PIG Base = 25% write off
146-160% HHS PIG Base = 10% write off
161-175% HHS PIG Base = 5% write off
C. To qualify for a write off percentage a patient must have a denial of Title XIX Medical Assistance coverage (Medicaid).
D. Assets should be considered in evaluating eligibility. While bountiful assets may be a reason for denying financial assistance, ordinary and routine assets will not be grounds for denying financial assistance for which an applicant qualifies under the Income Criteria.
• Review the patient's cash and non-cash equivalent assets. An individual will normally be eligible for financial assistance if their net worth is less than a prescribed amount (typically - $50,000) and his/her income is below the HHS PIG Base.
• "Ordinary and routine" assets include, but are not limited to, principal place of residence mortgaged or not; average automobiles or trucks, without regard to age; relatively small dollar amounts of cash.
E. The Fall River Health Services Administrator will be consulted for guidance when necessary to adjudicate complex or difficult applications.
F. The Chief Financial Officer is responsible for monitoring the Federal Register for updates to the HHS Poverty Income Guidelines, and for updating and publishing the Income Criteria Table on which this policy is based. The updated Income Criteria Table will become effective automatically on the first of the month following publications of the HHS guidelines in the Federal Register.
G. Granting charity care or financial assistance is at the sole discretion of Fall River Health Services with final authority delegated by the Board to the Fall River Health Services Administrator.