The BronxCare Network, composed of BronxCare Health Systems and Dr. Martin Luther King, Jr. Health Center (“MLK”) (each, an “Institution”), recognizes that many persons in our community require medically necessary health care services, but are uninsured or underinsured and, therefore, may not have adequate financial resources to pay for these health care services. This Charity Care and Financial Aid Policy (the “Policy”) reflects our commitment to provide charity care and financial assistance to persons in our community in furtherance of our charitable mission as a major voluntary healthcare provider committed to Excellence in Healthcare Services, Medical Education and Research. This Policy may be applied to other affiliates of the BronxCare Network, as determined by their respective governing boards.
In furtherance of the Institution’s charitable mission, it is our Policy to provide Charity Care and Financial Aid to eligible patients who cannot afford to pay for all or a portion of medically necessary services, including insurance coinsurances, insurance deductibles, and balances after exhausted coverage or other benefit coverage. Due to Federal Regulations, Medicare coinsurances and deductibles will be handled on a case by case basis. If a person other than patient requests information regarding this Policy, such information should, if possible, be provided at the time of the request. Our goal is to provide prompt, clear and understandable information that is consistent and is communicated in the patient’s primary language, generally English or Spanish.
Charity Care and Financial Aid require the expenditure of significant resources and funds by the Institution. Such expenditures include “Charity Care,” i.e., free care, and “Financial Aid,” i.e., discounts, reduced payments and extended payment schedules. Eligibility for Charity Care or Financial Aid under this Policy should be based on an individual determination of the patient’s needs and available resources.
The Institution’s financial commitment to Charity Care and Financial Aid and this policy will be established annually as part of the budget process and will be reviewed and approved by the Institution’s Board of Trustees/Directors (the “Board”) on an annual basis. The Institution’s debt collection policies, e.g., criteria for commencing a collection action and implementing post-judgment collection remedies, should be consistent with this Policy. Contracted collection agencies and/or collection attorneys should act in a manner that is consistent with this Policy.
Family: A family is a group of two or more persons related by birth, marriage, or adoption who live together, including domestic partners as defined by applicable law; all such related persons are considered as members of one family.
Income: Income is the family’s gross income reported for federal income tax purposes, including gross wages, tips, social security disability, veteran payments, alimony, child support, military, unemployment and public aid. Assets shall not be considered in determining assistance for patients at or below 200% of the Federal Poverty Guidelines.
As set forth in further detail below, Charity Care and Financial Aid are available for medically necessary services to those persons who reside in our community and who meet stated criteria. This Policy is applied uniformly, consistently, and equally for all eligible patients. To the extent reasonably possible, a patient should be evaluated for eligibility for Charity Care or Financial Aid when he/she initially presents for inpatient or outpatient services.
Charity Care and Financial Aid are available to persons:
• Who reside in the Institution’s Service Area, which is defined as the five boroughs, to include The Bronx, New York, Queens, Kings and Richmond and the county of Westchester; for emergent services all New York State zip codes are included, and
• Who are self-pay, have no health care coverage or governmental assistance, such as Medicaid, Managed Care coverage and cannot qualify for governmental assistance despite reasonable efforts to obtain such assistance, or have exhausted their health insurance benefits, and
• Whose income falls within 300% of the Federal Poverty Guidelines, but exceptions may be made on an individual basis due to extraordinary circumstances, as provided in this Policy.
• In addition, low income and, in some cases, middle income, persons who are unable to meet his/her financial obligations for medically necessary services due to the extraordinary high cost of those services, inadequate insurance coverage or similar reasons, may qualify on a case-by-case basis for Financial Aid under this Policy.
*Patients accessing services at sites which receive funding under Federal Section 330 eligible for Charity Care/Financial Aid without regard to their place of residence.
**Federal Section 330 grant funds shall not be used to provide any charity care/financial aid to patients whose income falls between 201% and 300% of the Federal Poverty Guidelines.
Experience has shown that many persons receiving medical care at the Institution would qualify for governmental assistance programs, if they provided the necessary information and documentation. Staff will educate patients on available options based on their eligibility for insurance and/or related third party coverage. Staff should assist the patient with completing an application to any applicable governmental program, but the patient should provide the necessary information and documentation and, preferably, sign the application. The application process should be completed while the patient is an inpatient or at the time of the current, but not later than the next, scheduled outpatient service.
If the patient refuses to cooperate, he/she will be treated as a “self-pay” patient. Any failure to cooperate under this Policy should be noted in the patient’s financial file and be considered when the patient next requests elective services.
The determination that a patient qualifies for Charity Care or Financial Aid will be re-evaluated (a) at each inpatient admission, and (b) at least every 12 months for outpatient services. Staff should request if there has been a change in financial circumstances, which may affect a patient’s eligibility under this Policy. If there is a change, the patient’s status should be updated.
This Policy generally requires a financial commitment by each patient to reinforce the principle that the patient has some degree of financial responsibility for his/her medical care. If the patient cannot make the payment required by this Policy when the services are provided, the patient should be permitted to receive the current service, but he/she will be informed payment will be required when the next elective service is provided. If applicable, the Institution should also determine if a patient is eligible for an extended payment plan. No patient will be denied services based on inability to pay.