Bronx-Lebanon Hospital Center

Patient Eligibility

How Do We Determine Eligibility?

1.

When registering or scheduling a patient, responsible Staff should inform all self-pay patients of this Policy, and, assist the self-pay patient in determining eligibility under this Policy. A “self-pay” patient does not have health insurance and does not receive benefits from a governmental assistance program, such as Medicaid, Family Health Plus or Child Health Plus.

  • The Financial Investigator or Medicaid Eligibility Specialist for inpatient services. OR
  • The Registrar/Receptionist, Financial Screener, or Call Center Associate for outpatient/clinic services.

2.

Self-pay patients who reside in the Institution’s Service Area, as defined above, should complete an application for assistance under this Policy and any applicable governmental program and provide supporting documentation of identity, address, household income and household composition.

3.

Staff will refer patients who may be eligible for governmental assistance, such as Medicaid, Family Health Plus, or Child Health Plus, to the appropriate program, e.g., Fulton HRA Office for Medicaid or the Department of Managed Care.

4.

Staff will review the application and determine if the patient qualifies for Charity Care or Financial Aid under this Policy.

5.

Eligibility should be determined prior to elective ordered ambulatory diagnostic and High Cost Outpatient services, such as MRI, CAT Scan, PET Scan, or LINAC.

6.

If the patient is eligible, Staff will determine what level of Charity Care and Financial Aid is applicable, as well as the patient’s financial commitment under this Policy. The patient, legal guardian or financially responsible person, as the case may be, should be advised of the determination, and each of these determinations should be documented in the patient’s file.

7.

The patient will receive a bill for the services provided. This bill should state that amount which is being provided as Charity Care or Financial Aid and that amount which is the patient’s financial obligation. Generally, the patient’s financial obligation will be a fixed amount for outpatient services or a percentage of what Medicaid would have paid for inpatient services.

8.

Staff should review the patient’s outstanding financial obligations when the patient arrives for outpatient services. If a patient has not made a payment between his/her last and current visit or within 60 days from his/her last visit, the case should be referred to the Practice Administrator or his/her designee, and, if necessary, discussed with the Medical Director, or his designee.

9.

The patient is allowed 90 days from the date of discharge or of service to apply for financial assistance and 20 days to submit a completed application (including all required documentation). A written response to all completed applications for Charity Care or Financial Aid approving or denying the application will be sent within 30 days after receipt of a completed application. If an application is not complete, the patient should be requested to provide the necessary information to complete the application. If the patient does not provide the requested information within the allowed timeframes, the application may be denied.

10.

Once a completed application, including required documentation or other information needed to make a determination on the request for Charity Care or Financial Aid has been submitted, the patient could disregard any bill that has been sent until the hospital had rendered a decision on the application.

11.

Eligible patients may request an extended payment plan. Installment payments will not be greater than 10% of gross monthly income.