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PATIENTS & VISITORS
Charity Assistance Program Policy
At SwedishAmerican Hospital we provide treatment, prevention and education of exceptional quality, value and service to our patients. We will provide medically necessary services, within our capacity, to our patients regardless of their ability to pay. If you feel you will need help to pay for your hospital services, please contact our Business Office in confidence at (815) 391-7380 to request information about our charity assistance program.
POLICY:
To establish guidelines for the discounting of account balances after insurance has paid and for the uninsured.
SCOPE:
This policy affects all departments concerned with identifying community assistance recipients and those responsible for crediting the patient account.
PRACTICE:
| A. |
Requests for Charity Assistance will be accepted from all SwedishAmerican Health System personnel as well as the patient or guarantor. Requests for charity assistance must have the following:
| 1. |
SwedishAmerican Health System financial disclosure form. This may be completed over the telephone. |
| 2. |
Proof of income (i.e., W-2 form, tax return, paychecks showing at least three (3) months' income); If you are unable to obtain proof, a credit report can be used. |
| 3. |
Account history reflecting payment activity. |
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| B. |
Approval for Charity Assistance will be granted based on the following:
| 1. |
Federal Poverty Income Guidelines |
| 2. |
Patient's cooperation in applying for State funding (i.e., Illinois Department of Public Aid). |
| 3. |
Patient assets. |
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| C. |
Approved Charity Assistance accounts will be discounted using our Community Assistance Income Guidelines assuming the patient/guarantor does not have significant assets to cover the amount owed. The income amounts in the Community Assistance Income Guidelines will updated by the Patients Accounts department based on changes to the Federal Poverty Guidelines.
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