Financial Assistance Policy
The following is a summary of UPMC's Financial Assistance Policy, effective Oct. 10, 2011. This is a general overview of the policy; UPMC will review each application individually to determine whether that patient and treatment qualify for financial assistance.
UPMC's policy is to provide financial assistance for patients who:
- Have limited or no health insurance.
- Have applied for governmental assistance, such as Medicare or Medicaid, but did not qualify.
- Demonstrate financial need.
- Reside in the primary service area of a UPMC provider.
- Supply UPMC with necessary information about household finances.
Financial assistance is available for eligible patients who require:
- Emergency medical services
- Nonelective services for urgent life-threatening conditions, outside the Emergency Department
- Other medically necessary services, on a case-by-case basis
Depending on the individual’s need, either free care or reduced patient financial obligations to UPMC hospitals or physicians may be offered. UPMC does not have the authority to waive any charges from physicians or other health professionals who are not employed by UPMC.
UPMC is committed to publicizing its Financial Assistance Program broadly within the communities it serves.
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
- Up to the resolution of his or her account
Determination of Eligibility for Financial Assistance
To request financial assistance, patients submit the UPMC Financial Assistance Application form (formulario de Solicitud de Asistencia Financiera) , disclosing household income and expenses. For nonemergency services, financial counselors will also conduct an interview with the patient before the date of service or discharge.
Applicants are treated with dignity and respect throughout the process; all information is handled with confidentiality. The patient’s cooperation in providing UPMC with necessary information is crucial to the process.
Typically, a patient is not eligible for UPMC financial assistance until he or she has applied for and been deemed ineligible for federal and Commonwealth of Pennsylvania governmental assistance programs. As a result, UPMC may make resources available to assist patients in enrolling in or applying for such programs. UPMC reserves the right to process the Financial Assistance Application without this determination, provided enough information is available to make an accurate assessment of the patient’s financial situation.
Determination of Assistance Amount
In determining a reasonable and fair level of assistance, UPMC applies a sliding scale.
If a patient’s income is below 400 percent of the federal poverty guidelines, the patient will receive some form of financial assistance.
|At or below 200 percent of the federal poverty guidelines:
- The patient is eligible for 100 percent financial assistance.
- The fees for UPMC services are completely waived.
|Between 201 and 400 percent of the federal poverty guidelines:
- The patient is eligible for an 85 percent reduction in charges from UPMC hospitals — in other words, the patient pays 15 percent of the charges.
- The patient is also eligible for a 75 percent reduction in charges from UPMC physicians — the patient pays 25 percent of the charges.
When financial assistance is less than 100 percent of charges, the fees for which the patient is responsible will not be more than is generally due from Medicare for such services.
In some cases, UPMC may recognize other financial or medical conditions that warrant financial assistance. If a patient's income falls outside the guidelines listed above, please contact UPMC's Financial Assistance Department at 1-800-845-1745 in order to review the circumstances. In any case, UPMC staff may be able to help establish a payment plan that helps patients pay their balance over time.
While UPMC’s Financial Assistance Program covers most services, there are some exclusions, such as, but not limited to:
- Cosmetic services
- Transplant-related services
- Bariatric-related services
- Elective reproductive services
- Private duty nursing
- Dental services
- Services deemed noncovered by Medicare
- Other services, at UPMC's discretion
Financial assistance is not typically available for:
- Insurance copayments
- Insurance deductibles
- People who fail to reasonably comply with insurance requirements, such as obtaining authorizations or referrals
Financial assistance is not available for people who opt out of available insurance coverage.
In addition, this policy does not apply to international patients who come to Pennsylvania in order to seek treatment from a UPMC provider.
To provide patients with a quality Financial Assistance Program, UPMC:
- Performs random audits of applicable patient accounts to ensure that financial assistance is communicated and administered in compliance with the terms of this policy.
- Provides extensive Financial Assistance Policy training and education to UPMC staff.
- Reviews this Financial Assistance Policy annually for clarity, applicability, and legal compliance.