Financial Assistance Policy
Scottsdale Lincoln Health Network ("Network") is committed to providing the best care possible for all of our patients and assisting each person entrusted to our care to enjoy the fullest gift of health possible. In pursuit of this goal, the Network will provide financial assistance for emergency and other urgent medically necessary hospital care to uninsured and underinsured patients who meet the financial and documentation criteria defined in this Financial Assistance Policy ("Policy"). The Network has a responsibility to operate in a prudent manner that enables it to continue its services; therefore, the Network seeks to objectively evaluate the circumstances of individual patients and responsible parties and to offer free or discounted services where it is needed and appropriate with respect to sound business practices.
This Policy does not apply where the Network has lien rights pursuant to A.R.S. Sections 33-931 – 33-934, meaning if there is a lien settlement the Network will collect lien funds. Each situation will be reviewed independently and allowances will be made for extenuating circumstances based on the following procedure:
Financial Assistance Procedure
Emergency and Other Medically Necessary Care. Non-elective emergency or other urgent care is limited to care defined as medically necessary according to Arizona State Medicaid guidelines.
Family Income: Total compensation received by all family members age 18 or older living in the same household.
Uninsured: Individuals without health insurance who do not qualify for Medicaid.
Underinsured: Individuals without adequate health insurance coverage or who can't afford their deductible.
B. Eligibility Criteria for Financial Assistance: In determining whether a patient meets the eligibility criteria for financial assistance, the Network considers the extent to which the person has income or other assets that could be used to satisfy his or her financial obligation. The Network will consider employment status to determine the likelihood of future earnings sufficient to meet the healthcare related obligation within a reasonable period of time (e.g., patient is temporarily unemployed, but when employed can pay obligation). Financial assistance is not available to those who have insurance but choose not to bill it. Where a patient does not have assets other than income that can be used to satisfy their Network bill, financial assistance is available as follows:
- Free Care. A patient will receive a full (100%) discount against gross charges if he or she can demonstrate family income at or below 200% of federal poverty guidelines.
- Discounted Care. Other financial assistance discounts against gross charges are available at higher income levels and are subject to the Network's income and asset verification processes and other Network financial assistance eligibility requirements.
- Financial Assistance Attestation Process: Uninsured patients who qualify for a discount based on their income levels will receive a discount against gross charges. Such self-pay patients may complete an attestation of income and assets in lieu of a full financial assistance application.
- Discretionary Authority, In case of extreme hardship or for compassionate circumstances, the Director of Patient Financial Services ("Director") has discretionary judgment to grant assistance to patients who would not otherwise qualify for financial assistance. In cases where the patient is unable or unwilling to cooperate, or if documentation provided is insufficient to fully evaluate a patient's financial situation, the Director will use best efforts to identify potential needs using credit reports, prior or current AHCCCS enrollment, and other information readily available. In such cases, the Director will have discretionary authority to grant free or discounted care to a patient where the authorized employee is satisfied that the client is unable to pay rather than unwilling to pay his or her financial obligation.
- The Network's use of federal poverty guidelines will be updated annually in conjunction with the federal poverty guidelines published by the United States Department of Health and Human Services.
C. Method of Applying for Financial Assistance. Patients will be encouraged to apply for financial assistance before, during, or within a reasonable time after the Network care is provided.
- Financial Assistance Application: Patients may apply for financial assistance at the Patient Financial Services office either in person, through a surrogate, through a family member or through another appropriate party. The patient, or his or her surrogate, must provide the Network with financial and other information needed to determine eligibility under this Policy. The Patient must also provide the Network with financial and other information needed and apply for other existing financial resources that may be available to pay for his or her health care. (e.g., Medicare, Medicaid, AHCCCS, third-party liability, etc.). Visits within 6 months of treatment may be covered without having to complete a new financial assistance application pursuant to the discretion of the Director of Patient Financial Services.
- Notification of Decision: The Network will notify the patient within a reasonable period of time (usually 30 days) after receiving the patient's request for financial assistance and any financial information or other documentation needed to determine eligibility for financial assistance. The Network will also advise the patient of his or her responsibilities under these financial assistance guidelines. When the patient has been approved under the Network's Policy for a discount, the Network will work with the patient or responsible party to establish a reasonable payment plan that takes into account available income and assets, the amount of the discounted bill(s), and any prior payments.
- Changed Circumstances: In the event they do not initially qualify for financial assistance after providing the requested information and documentation, patients may reapply if there is a change in their income, assets, or family size responsibility. In addition, the discount may be reversed if subsequent findings indicate the information relied upon was in error.