The Franciscan Missionaries of Our Lady Health System is committed to providing financial assistance to those who have healthcare needs and are uninsured or underinsured, for emergency or medically necessary care, based on the patient’s individual financial situation. Patients seeking financial assistance must apply for the program, which is summarized below.
What services are covered?
The Financial Assistance Policy (FAP) covers emergency and medically necessary services provided to uninsured and underinsured patients at our hospitals. Assistance for underinsured patients is meant to address gaps in coverage and does not cover co-pays, deductibles or co-insurance for insured patients. The policy also does NOT cover: Cosmetic procedures; charges resulting from procedures that are not covered by third-party insurance due to the patient’s failure to follow insurance payer guidelines where a patient knowingly received services in a non-contracted hospital; motor vehicle accidents where third-party liability is being pursued for payment of hospital expenses; and other services as determined by the hospital.
How to apply?
The FAP and application may be obtained from the hospital websites, by mail, or in person at each hospital’s Admissions Department. Complete the application, include all requested documents and submit to the hospital’s Admissions Department or by mail to the address listed on the application.
Who qualifies for financial assistance?
One of the qualifying factors is family income based on the U.S. Department of Health and Human Services Federal Poverty Level (FPL) table as published annually in the Federal Register. Eligibility for write-off is determined based on the number of persons in the household and annual family income as a percentage of the FPL. Qualifying patients receive a full write-off of all hospital charges, excluding any Standard Deposits previously paid, assuming they meet the other eligibility criteria set out in the FAP.
- Uninsured, income up to 275% of FPL or
- Uninsured with income greater than 275% of FPL and medical expenses for the preceding 12 months exceeding 20% of family income may qualify.
- Underinsured will be treated as uninsured for the purposes of this FAP.
See detailed information in the policy using the links below.
Eligible patients will not be charged more for emergency and other medically necessary care than Amounts Generally Billed (AGB) to those patients who have insurance.
The Plain Language Summary, FAP and Application will be offered in multiple languages at the Admissions Departments and by using the links below.
Family income includes the income of all family members who reside together and dependents claimed on the income tax return. The following income is used when computing family income: Earnings, unemployment compensation, workers’ compensation, Social Security, Supplemental Security Income, public assistance, veterans’ payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, resources or property that are easily convertible to cash, and other miscellaneous sources. Family income is determined on a before-tax basis.
