Recognizing the medical needs of the poor and uninsured, Vista Health provides quality medical healthcare services regardless of ability to pay.

Although reimbursement for services provided is critical to the continuation and stability of our mission, it is recognized that not everyone has the financial ability to purchase essential medical services. Therefore, in keeping with the organization's commitment to serving all members of its community, free or discounted care will be considered where the need exists. Free or discounted healthcare services will be made available based on established criteria.

All patients will be treated with equal dignity and respect at all times, regardless of their ability to pay. Application and evaluation processes for free or discounted services will be designed with the patient's privacy in mind.

PURPOSE

This policy identifies situations when Vista Health may provide free or discounted healthcare services to a patient whose financial status makes it impractical or impossible to pay for the services provided. If not provided free of charge, services may be discounted in direct proportion to the patient's ability to pay. The necessity for medical treatment of any patient will be based on clinical judgment without regard to the financial status of the patient.

SPECIAL INSTRUCTIONS/FORMS TO BE USED

DEFINITIONS OF TERMS

Bad Debt Expense: The provision for actual or expected uncollected accounts receivables resulting from the extension of credit.

Charity Assistance: Healthcare services that were never expected to result in cash inflows. Charity assistance results from Vista Health's policy to provide healthcare services free of charge or at discounted levels to individuals who meet certain financial criteria.

Contractual Adjustments: Differences between income at established rates and amounts realized from third party payers (insurance companies, etc.) under contractual agreements.

 Family Income: Wages, salaries, dividends, interest, Social Security benefits,

unemployment benefits, welfare payments, child support, alimony, strike benefits, workers' compensation benefits, veterans benefits, training stipends, military allotments, regular support from family member(s) not living in the household, government pensions, private pensions, insurance and annuity payments, income from rents, royalties, estates and trusts, retirement and pension benefits are considered family income.

To be eligible for free or discounted care, the patient's family income must be at or below the levels outlined in Attachment 1. After the charity adjustment has been worked out, the remaining balance will be treated according to Vista Health's Patient Accounting policies regarding self-pay balances. Payment terms will be established on the basis of disposable income (see Attachment 3).

PROCEDURE

1. PRE-ADMISSION INTERVIEW

 Where possible, prior to the actual admission or date of service of the patient, Vista Health will conduct a pre-admission interview with the patient, the responsible party and/or his/her representative. If a pre-admission interview is not possible, this interview should take place upon admission or as soon as possible, thereafter. In the case of an emergency admission/service, Vista Health's evaluation of payment alternatives will not take place until the required medical care has been provided. At the time of the initial patient interview, the following information should be gathered:

- Routine and comprehensive demographic data as seen on the " PRELIMINARY APPLICATION FOR CHARITY ASSISTANCE".

- Complete information regarding all existing third party coverage

2. DETERMINING BENEFIT COVERAGE

 Eligibility for and availability of any insurance benefit coverage levels should be determined. Verification with appropriate insurance companies and/or employers should follow routine Vista Health procedures.

• Estimate actual patient costs based on the patient's expected length of stay or services to be provided
• Interview the patient, the responsible party and/or his/her representative to determine his/her ability to pay anticipated balance due.
• Identify and begin application for any available programs (i.e., Medicaid) for which the patient may qualify.

3. OFFER APPLICATION

A. Based on the outcome of the above steps, patients who appear unable to meet their anticipated financial obligations should be offered the opportunity to apply for Charity Assistance. The patient, or if the patient's condition prohibits his/her involvement the patient's representative, should be directed to Patient Accounts for a financial evaluation. When no representative of the patient is available, Vista Health must take over the responsibility of representing the patient, applying for available programs, including Charity Assistance (see Attachment 3).

B. Application Documentation

The patient, or his/her representative, should receive a written application. That application will include a request for all supporting information required to verify the patient's eligibility for Charity Assistance.

Income, liquid assets and living expenses will be the main considerations used to determine whether an individual qualifies for Charity Assistance. The patient, or his/her representative, must sign the completed application. Family income, including wages, salaries, welfare payments, Social Security payments, and other forms of income must be documented. Additional information such as tax returns, W-2's, pay stubs, rent receipts or cancelled checks may be requested as support documentation.

Any form of insurance plan or government program must be reviewed.

4. TIME FRAME FOR APPLICATION/REVIEW AND NOTIFICTION OF DECISION

 At the time of application, the patient should be informed of how long it will take to review his/her application and when he/she can expect to receive a decision. A prompt turnaround and a response that includes the reason for denial (if applicable) is recommended.

5. AUTHORIZATION PROTOCOL

 A record, paper or electronic, should be maintained reflecting authorization of Charity Assistance.

On completion of the application and submission of appropriate documentation, the information will be forwarded to the Director of Patient Accounts. Determination of Charity Assistance approvals will be made according to the following guidelines:

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