Grace Cottage Hospital’s 2009 Hospital Report Card

PURPOSE:

To provide a process for uninsured/under insured patients to take advantage of discounts for fee services depending on income levels.

POLICY:

1. Any patient of Carlos G. Otis Health Care Center, Inc. (OHCC) has the right to apply for reduced fees regardless of where they live or their income status. OHCC shall determine reduced fee eligibility on an equal basis. OHCC will make every effort to obtain payments due from all patients.
2. Fees for services at OHCC will be discounted based on family size and the family’s gross monthly income for the period the Sliding Fee is requested. Federal Poverty Guidelines for Vermont per the Federal Register will be the only criteria used for the adjustment of fees.
3. Patients with third party resources recoverable by OHCC (i.e. Medicare, Medicaid, private insurance, worker’s compensation, etc.) may still be eligible for discounts on the balance that the third party does not cover. Before an application is submitted, all other possible resources must be exhausted.
4. Proof of sliding fee reduction will be checked and documented at the end of the designated time frame.
5. Income must be reported for all members of the applicants’ household.
6. The application must be filled out completely and returned to the VP of Clinic Services with all required income verifications and appropriate documentation.
7. Sliding Fee reductions will not apply unless all requested materials have been obtained.
8. Income verification may include the following:
   1. Paycheck stubs showing gross income earned by all members in the household for the year Sliding Fee is being applied for. If an individual cannot produce documentation verifying income, they will be allowed to bring a letter from their employer on company letterhead and signed by the employer stating their gross annual income.
   2. Unemployment check stubs
   3. Social security check stubs
   4. Letter of award from Social Security, welfare or the like
   5. Copies of previous year tax return for all wage-earning household members.
9. Approved applications are valid only for one year. However if the patient has a change of income it is his/her responsibility to notify OHCC of that change.
10. Patients may receive a bill before the end of the month showing full amount charged. Their reduction rate will appear on an updated bill if they qualify. The patient will be notified of the reduced rate in writing from OHCC.
11. Applicants for the reduced fee will be referred to our Resource Advocate for assistance with this and other programs.

Approved by: Mick Brant, Administrator & CEO
Effective: March 1, 2009

Attachments:

• 2009 Poverty Level Guidelines
• Application for Free or Reduced-Fee Health Care (PDF)