Financial Assistance
The following is a summary of UPMC's Financial Assistance Policy, effective January 1, 2008:
It is the policy of the University of Pittsburgh Medical Center to provide financial assistance for patients who:
- have limited or no health insurance
- have applied for but are deemed ineligible for governmental assistance (e.g., Medicare or Medicaid)
- cooperate with UPMC by supplying UPMC with pertinent information about household finances
- demonstrate financial need
Consistent with its charitable mission of providing health care services to residents of western Pennsylvania regardless of their financial status and ability to pay, UPMC offers financial assistance to eligible individuals and families. This assistance applies to emergency care and to services that are medically necessary but not of an emergent nature. Depending on the individual’s need, either free care or reduced patient financial obligations may be offered, applicable to certain UPMC physician charges as well as hospital services. UPMC does not have the authority to waive any charges from physicians or other health professionals who are not employed by UPMC.
Assistance Request Process
Each patient has the opportunity to apply for financial assistance at all times throughout his or her relationship with UPMC — prior to treatment, throughout treatment, and up to the resolution of his or her account. To request financial assistance, patients submit an application form regarding household income and expenses. Financial assistance applications are available in the offices of physicians employed by UPMC and in areas where patients are registered at UPMC hospitals, and signage about financial assistance is posted at these locations. Patient billing statements reflect Financial Assistance contact information. A Financial Assistance Flier and the “Insurance Information Booklet for Patients” also may be downloaded from each hospital’s web site. Applicants are treated with dignity and respect, and all information is handled with confidentiality (see Notice of Privacy Practice). UPMC has trained staff who can assist patients with exploring all financial options available and who can help patients complete the required application form. Because a patient cannot receive assistance under this policy until he or she has applied for and been deemed ineligible for federal and Commonwealth governmental assistance programs, UPMC assists patients in applying for these programs. UPMC also provides translation services as needed. The patient’s cooperation in providing UPMC with necessary information is crucial to the process. For non-emergent services, financial counselors conduct an interview with the patient before the date of service or discharge.
Determination of Eligibility and Assistance Amount
In determining a reasonable and fair payment, UPMC applies a sliding scale. If a patient’s income and assets combined are below 400% of the federal poverty guidelines, the patient will receive some form of financial assistance.
- If a patient’s income and assets combined fall below 200% of the federal poverty guidelines, the patient will have no financial responsibility for care provided; the fees for UPMC services are completely waived.
- If a patient’s income and assets combined fall between 201% and 300% of the federal poverty guidelines, the patient is eligible for financial assistance in the form of an 80% reduction in charges. This means that the fees for UPMC services are limited to a maximum of 20% of the charges.
- If a patient’s income and assets combined fall between 301% and 400% of the federal poverty guidelines, the patient is eligible for financial assistance in the form of a 70% reduction in charges. This means that the fees for UPMC services are limited to a maximum of 30% of the charges.
- If a patient’s income and assets combined fall above 400% of the federal poverty guidelines, the patient is eligible for financial assistance in the form of a 20% reduction in charges. This means that the fees for services are limited to a maximum of 80% of the UPMC charges.
UPMC also considers financial assistance in cases of medical hardship where the patient’s medical bills are so great that they threaten the patient’s financial survival.
Certain medical procedures are excluded; some examples are cosmetic surgery when it is not medically necessary, bariatrics, acupuncture, in vitro fertilization, and procedures not deemed medically necessary. Financial assistance is not available to international patients.
Quality Assurance
UPMC performs random quarterly audits of applicable patient accounts to ensure that financial assistance is communicated and administered in compliance with the terms of this policy. UPMC provides extensive financial assistance policy training and education to those key staff who are most likely to interact with the patient, including registration and patient accounting managers and staff, social workers, care managers, medical information staff, patient relations, financial counselors, and chief financial officers. UPMC’s employee orientation program includes a summary of the financial assistance policy and the contact telephone number to which patients may be directed.
UPMC reviews this Financial Assistance Policy regularly to ensure clarity, applicability and legal compliance.
Collection Practices
No collection process is begun until the financial assessment process is complete. UPMC will not pursue third-party collections prior to determining a patient’s eligibility for financial assistance. UPMC will not pursue legal action for nonpayment of bills for any patient receiving financial assistance so long as the patient is making payments in accordance with his or her established payment plan. As part of UPMC’s outside collection agency contracts, quarterly audits are performed to ensure that this policy is administered and communicated through UPMC’s third-party collection services. The results of these audits are communicated to the third-party vendors.