We have designed a Financial Assistance Policy (FAP) to help our patients who are financially unable to pay for healthcare services. The FAP outlines general guidelines for providing assistance to patients and families. It addresses the most common situations that may happen. It is not intended to be all inclusive.
- Financial Assistance Policy
- HAMH Financial Assistance Plain Language Summary
- Financial Assistance Application
- Financial Services Policy – List of Providers
- Financial Assistance – Non Covered Providers
- No patient will be denied financial assistance because of their; race, creed, nationality, origin, citizenship or immigration status.
Financial assistance will be provided to any families who are determined to be unable to pay all or part of billed charges. This includes co-payments, co-insurance and deductibles. - Financial assistance will be given after insurance coverage, government assistance programs and other benefits available to the patient have been explored and used.
- Non-compliance with insurance policy guidelines (for example, appeals, referrals, non-authorized services) or failure to pursue available government assistance programs before requesting assistance may prevent participation in the Financial Assistance Program.
HAMH will provide care for emergency medical conditions to anyone. - A determination letter will be sent to the patient after the application has been processed. If financial assistance is denied, an appeal can be filed with the Patient Financial Services Department.
- Determinations are generally made within two weeks following the receipt of the Financial Assistance Application.
Patient eligibility for assistance is determined by measuring family income against the current poverty guidelines as established by the Department of Health & Human Services.
All income in the patient’s household will be considered when determining ability to pay. This includes gross wages, government payments, pensions, child support, unemployment compensation, car accident or personal injury payments, and any other payments that are considered income by the U.S. Internal Revenue Service.
The following information/documentation must be provided by the applicant to substantiate financial information provided on the application:
- Copies of payroll checks or check stubs reflecting year to date gross wages
- Copy of social security determination of benefits
- Copies of income tax return, including w-2’s
- Copies of previous 3-months bank statements