419-354-8900

Wood County Hospital Financial Assistance Policy

Financial Assistance Policy

And

Billing and Collections Policy

 

PURPOSE

The Financial Assistance Policy outlines the eligibility options for uninsured and underinsured patients who require emergency or medically necessary services at Wood County Hospital.  Qualified patients will receive free or discounted care in accordance with the eligibility criteria and determination processes outlined in this document.

EMERGENCY MEDICAL CARE

Wood County Hospital provides, without discrimination, care for emergency medical conditions to individuals regardless of whether they are eligible for assistance under this financial assistance policy.  Wood County Hospital will provide care in compliance with the Emergency Medical Treatment and Labor Act (EMTALA).  Wood County Hospital will not require payment from individuals before receiving treatment for emergency medical conditions or pursue debt collection activities that interfere with providing emergency medical care.

ELIGIBLE SERVICES

This financial assistance policy applies to all emergency and other medically necessary care provided by Wood County Hospital.  The following services are not covered under this policy: self-pay bariatric charges, cosmetic surgery, and elective services deemed non-covered by insurances as not medically necessary. 

 

Services not provided and billed by Wood County Hospital are not covered by this financial assistance policy.   This includes, but is not limited to, physicians providing services in the emergency room, the radiologist group, the anesthesia physicians and CRNAs, any Wood Health Company employed physicians and practitioners, or any other independent physician who provides services at Wood County Hospital.

Amounts Charged to Uninsured Patients

Wood County Hospital will not charge an uninsured patient approved for financial assistance under this policy for emergency care or other medically necessary care, more than the amounts generally billed (AGB) to individuals who have insurance.  Gross charges will be provided on the billing statement and used as the starting point for allowances, discounts, and deductions.

Wood County Hospital uses the look-back method to determine AGB.  The hospital will determine AGB annually by dividing the sum of the amount of all claims for emergency and other medically necessary care that have been provided by private health insurers and Medicare fee-for-service insurers during a prior 12 month period by the sum of the associated gross charges for those claims.  The current AGB is calculated to be 29%.

ELIGIBILITY CRITERIA

  • Financial assistance eligibility is based on household income and the number of members in the household, in compliance with federal poverty guidelines. A household includes the parent(s), their spouse(s), and all their children, natural or adoptive, under the age of eighteen.
    • Proof of income for the three months prior to the date of service is required.
      • Proof of income may include: pay stubs, W2s, copy of paychecks, bank statements showing direct deposits, child support/alimony documents, social security/disability award letters. 
      • For the self-employed, a written declaration of income along with the previous year’s tax return is required.
    • In the event that the patient has no income, a written statement is required indicating how they are supporting their living expenses.
  • Wood County Hospital will not deny assistance due to a failure to provide information/documentation not specified in this policy or on the application.
  • The patient must be a resident of the state of Ohio, and not a current Medicaid recipient.
  • Patients who have insurance, must comply with any requests from their insurance company before being eligible for financial assistance.
  • Individuals with an income level at 100% of the Federal Poverty Guidelines (FPG) or below qualify for 100% discount (free care) through the HCAP program.
  • Individuals with an income level between 101% and 200% FPG qualify 100% discount (free care) through Wood County Hospital’s Uncompensated Care program.
  • Uninsured individuals over 200% up to 400% FPG will qualify for a sliding scale discount on this basis, after AGB discount has been applied:
    • 201% - 225% FPG receive 90% discount
    • 226% - 250% FPG receive 80% discount
    • 251% - 275% FPG receive 70% discount
    • 276% - 300% FPG receive 60% discount
    • 301% - 325% FPG receive 50% discount
    • 326% - 350% FPG receive 40% discount
    • 351% - 375% FPG receive 30% discount
    • 376% - 400% FPG receive 20% discount
  • Individuals over 400% may be eligible for a prompt pay discount for payment in full or make arrangement for a payment plan either with Wood County Hospital or a bank loan program through Commerce Bank. Individuals should contact Patient Accounts at 419-373-7611 or 419-354-8972 to discuss these options.

 

 

PRESUMPTIVE ELIGIBILITY

Presumptive eligibility will be provided to those uninsured patients on the basis of individual situations including, but not limited to:

  • Pending Medicaid approval
  • Homeless patients
  • Deceased patients with no known estate
  • Patients who filed bankruptcy

 

PATIENT COMMUNICATION

  • Wood County Hospital notifies patients that financial assistance is available through signage posted within the hospital, via the hospital website, information on guarantor statements, through contact with patient accounting representatives, and staff identification of patients with potential financial need.
  • Assistance is offered, free of charge, to complete assistance applications for the following programs:
    • Ohio Medicaid
    • Hospital Care Assurance Program (HCAP)
    • Wood County Hospital Uncompensated Care Programs
  • Patients may request financial assistance at any time prior to or during the scheduling process, pre-registration, registration, testing, hospital stay, or throughout the course of the billing and collections cycle.
  • A copy of the financial assistance policy and plain language summary are available in English or Spanish, free of charge at woodcountyhospital.org/patients-visitors/billing-and-insurance, from Patient Accounts at 419-354-8972 or 419-373-7611, in the emergency room, or registration areas, or by writing to Wood County Hospital, Attn: Patient Accounts, 950 W Wooster St, Bowling Green, OH 43402.

APPLICATION PROCESS

  • Financial assistance applications may be obtained from the Wood County Hospital website at woodcountyhospital.org/patients-visitors/billing-and-insurance/financial-options, by contacting Patient Accounts at either 419-354-8972 or 419-373-7611, or by writing to Wood County Hospital, Attn:Patient Accounts, 950 W. Wooster St, Bowling Green, OH 43402.
  • Completed applications and proof of income need to be submitted to Patient Accounts, Attn:Financial Counselor, 950 W Wooster St, Bowling Green, OH 43402.
  • Financial assistance determinations will be made in a timely fashion and will not attempt to collection efforts while application is being reviewed.
  • If the application is incomplete, efforts will be made to contact the patient either via phone or in writing for the necessary information. Collection activities will be suspended while attempting to obtain the missing information.  If the applicant fails to respond with the required information within a reasonable time period, the application will be denied.
  • Once a determination is made, the patient will be notified in writing of the decision.
  • Inpatients are required to complete an application for each admission, unless the patient is readmitted within 45 days of discharge for the same underlying condition. Approved inpatient applications may also cover outpatient services for the 90 day period following the first day of inpatient admission.
  • Approved outpatient applications are effective for 90 days from the initial date of service.
  • Applications may be denied if there is a reasonable doubt that the applicant is not telling the truth.
  • Applications and documentation will be retained for three years.
  • Patients who qualify for free care at 100% of FPG or less and who have made payments will be refunded or credited that amount, unless the credit balance is less than $5.00.
  • Wood County Hospital will accept applications for dates of service up to three years in the past.
  • For applications that have qualified for free care, if the account had been referred to a collection agency, it will be closed by the agency. In addition, the agency will report that the debt is no longer owed and remove it from credit reporting.  If the account has been referred to legal, patient will still be responsible for any associated court costs.

 

BILLING AND COLLECTION PRACTICES

A statement of hospital services is sent to the patient/guarantor in incremental billing cycles.  In cases where the patient is uninsured, the statement is sent after services are rendered. In most cases where patients have coverage through an insurance carrier, the statements are sent after services have been adjudicated by the insurance carrier.  There are some cases where adjudication has been stopped by the carrier due to the patient/guarantor needing to provide additional information. In these situations, statements will be issued to the patient/guarantor. Statements are generated in 30 day increments. 

 

Wood County Hospital representatives and/or their designees may attempt to contact the patient/guarantor during the statement billing cycle in order to pursue collections.  Collection efforts are documented on the patient’s account.

 

Wood County Hospital will not engage in extraordinary collection actions (ECA) against a patient/guarantor to collect payment for care, unless it has made reasonable efforts to determine if the patient/guarantor is eligible for assistance.  Wood County Hospital will not engage in ECAs against the patient/guarantor without making reasonable efforts to determine the patient’s eligibility under the financial assistance policy and making patient’s aware of the policy.  Once 120 days have passed from the first post-discharge statement date and no application has been received, nor other payment arrangements established, the outstanding balance will be forwarded to a collection agency.

 

Patients/guarantors are responsible for providing a current mailing address at the time of service or upon moving.  If an account does not have a valid address, the determination of ‘reasonable effort’ will have been made.

 

Patients/guarantors who failed to comply with the agreed upon arrangements for a repayment contract or have defaulted on a Commerce Bank loan program may be referred to a collection agency for unpaid debt, unless an financial assistance has been submitted or payment in full has been received.

 

Wood County Hospital may pursue the following ECAs:

  • Selling a patient/guarantor’s debt to another party
  • Reporting adverse information about the individual to consumer credit reporting agencies or credit bureaus
  • Actions that require legal process, including, but not limited to, placing a lien on a guarantor’s property, foreclosing on a guarantor’s property, attaching or seizing an guarantor’s bank account, or any other personal property, commencing a civil action against a guarantor, causing a guarantor to be subject to arrest or body attachment and garnishing an individual’s wages.

 

Wood County Hospital will work with all patients to establish suitable payment arrangements if payment in full cannot be made after the first statement has been delivered to the patient/guarantor.  Interest free repayment contracts with defined payment timeframes on outstanding balances are available to all patients/guarantors.  Prompt pay discounts and an interest free bank loan are additional options for satisfying account balances.    

 

Accounts submitted to an external collection agency meet the following criteria:

  • The agreement with the collection agency is in writing and includes a code of conduct.
  • The agreement defines the standards and scope of practices to be used by outside collection agents acting on behalf of Wood County Hospital, all of which must be in compliance with this procedure.
  • No legal action may be undertaken by the collection agency without prior written permission from Wood County Hospital.
  • All decisions as to the manner in which the claim is to be handled, whether suit is to be brought, whether the claims is to be settled, whether the claim is to be returned to Wood County Hospital, and any other matters related to resolution of the claim shall be made by Wood County Hospital.
  • Wood County Hospital reserves the right to discontinue collection actions at any time with respect to any specific account.