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Charity Care

Charity Care/Financial assistance application

This is an application for financial assistance (also known as charity care) at Arbor Health, Morton Hospital, and clinics.

Washington state requires all hospitals to provide financial assistance to people and families who meet certain income requirements. You may qualify for free care or reduced-price care based on your family size and income, even if you have health insurance.

Sliding Scale Financial Assistance Form

Financial assistance application form in English

Formulario de asistencia financiera en español

We want to help. Please submit your application promptly!

You may receive bills until we receive your information.

Financial assistance plain-language summary

Lewis County Hospital District No. 1 (LCHD No. 1) cares for you and your healthcare needs regardless of your ability to pay. We are committed to working with you, on your financial needs related to your care. This includes, finding ways to make your care more affordable. LCHD No. 1 offers financial assistance to our eligible patients who do not have the financial means to pay for their healthcare expenses. If you are having trouble paying for all or some of your health care expenses at one of our Arbor Health facilities, we encourage you to talk with a Patient Account Representative about options to help you with these expenses.

What is covered

We provide financial assistance to eligible patients on a sliding fee scale for medically necessary services. Our discounts range from 15% to 100% based on the Federal Poverty Guidelines.

How to Apply

A patient seeking financial assistance must provide supporting documentation outlined in the “financial assistance application,” form unless LCHD No. 1 indicates otherwise. The application form may be obtained as follows; online through our website, by calling the number below, or by visiting our hospital or clinics.

360-496-5328 or 800-339-0791.

Online Financial Assistance Applications in English

Online Financial Assistance Applications in español

Other Assistance

If you are without healthcare insurance, you may be eligible for other government and community programs. We can help you research and apply for other programs that may be available to you. Other programs may include: Medicare, Medicaid or Veterans Affair.

Limitations on Charges

LCHD No. 1 uses the “Amounts Generally Billed” (AGB) formula to determine the discount amounts that will be offered to uninsured patients, who otherwise do not qualify for financial assistance. The AGB is determined by looking at all billed and paid claims from the prior year. The net payment amount is used to determine the average payment amount per financial class. The intent is to not charge our self-pay patients more than we expect an insurance company to pay. This discount (501r) applies to emergent and medically necessary services for all Arbor Health Clinics and Arbor Health Morton Hospital services. The AGB calculation is used to determine the discount for the following calendar year.

Payments

After your insurance company processes your claim, any balance for amounts owed by you, is due within thirty days, unless other arrangements have been made. We accept; cash, check, online bill-pay, or credit cards. If you would like to establish a payment plan, please call the number listed below. Balances not paid, may be assigned to an outside collection agency and are subject additional fines, penalties and fees. If you would like a copy of our collection policy, please call patient accounts at 360-496-3707.

Emergency Care

LCHD has a dedicated emergency department that provides care for emergency medical conditions (as defined by the Emergency Medical Treatment and Labor Act) without discrimination, regardless of your ability to pay for services.

List of Providers/Entities Not Covered

Per Reg. Sec. 1.504(r)-4(b)(1)(iii)(F) and Notice 2015-46, this list specifies which providers of emergency and medically necessary care delivered in the hospital facility are covered and not covered. Elective procedures and other care that is not emergency care or otherwise medically necessary are not covered by the FAP for any provider.

PHYSICIANS or MEDICAL GROUPS COVERED

PHYSICIANS or MEDICAL GROUPS NOT COVERED

All Arbor Health clinic providers (physicians, physician assistance, nurse practitioners and licensed clinical Social workers.

  • Arbor Health Massage Therapist
  • Arbor Health Anesthesiologist/CRNA’s
  • Providence Hospital and Affiliates
  • Arbor Health Emergency Room providers
  • South Sound Radiology Group
  • Arbor Health Surgery Providers
  • LabCorp
  • Arbor Health Method II Providers
  • PeaceHealth
  • Arbor Health Physical Therapist, Occupational Therapist and Speech Therapy
  • St. Joseph’s Hospital and Affiliates
  • Arbor Health Locum Tenens
  • Assured Hospice and Home Health
  • Arbor Health Contract Providers
  • Non-Arbor Health Providers
  • Arbor Health Respiratory Therapist
  • Radia Inc.
  • All Arbor Health Clinics; Morton Clinic, Mossyrock Clinic, Randle Clinic and Specialty Clinic.
  • Pacific Medical Group-DME

For more information about getting help with your Arbor Health, Morton Hospital, medical bills, please call or visit a financial counselor or billing office at your local Arbor Health facility. We can give you any forms you need and can help you apply for assistance. Patients are strongly encouraged to ask for financial help before receiving medical treatment, if possible. Patients can also apply at any time while receiving treatment and for a period of time following receipt of your initial bill.

360-496-5328 or 800-339-0791

Definitions

Charity Care/Financial Assistance

Medically Necessary and/or Emergency Care services provided for free or at a reduced price for patients who have no or limited income and who would otherwise be unable to pay for their treatment. Charity Care is also referred to as uncompensated care and financial assistance.

Indigent Care

Under 42 CFR Section 413.89, Medicare is to reimburse deductible and coinsurance amounts for Medicare beneficiaries that remain unpaid after the provider has made a reasonable effort to collect. The provision is to assure that the covered costs of Medicare beneficiaries is paid. If the patient is presumed indigent, the provider must bill Medicaid (if eligible) before any unpaid deductible or coinsurance can be claimed. In addition, if no other coverage, and limited income, the patient may also qualify for indigent care. Debts are adjusted as Medicare bad debt and are not considered a contractual adjustment.

501(r) IRS Regulation

The Affordable Care Act imposes four requirements on non-profit hospitals and health systems in order to maintain their tax-exempt, non-profit status. Three of these requirements relate directly to the revenue cycle operations including a Financial Assistance policy (FAP), set charge limits (AGB) for FAP eligible patients and make reasonable efforts to determine FAP eligibility before engaging in extraordinary collection activity against an individual.

Asistencia financiera Resumen en lenguaje sencillo

El Hospital del condado de Lewis Distrito N° 1 (LCHD N° 1) se ocupa de usted y de sus necesidades de atención médica independientemente de su capacidad de pago. Nos comprometemos a colaborar con usted en sus necesidades financieras relacionadas con su atención. Esto incluye encontrar maneras de que su atención sea más accesible. El LCHD N° 1 ofrece asistencia financiera a sus pacientes elegibles que no tienen los medios económicos para pagar sus gastos de atención médica. Si tiene dificultades para pagar parte o todos los gastos de su atención médica en uno de los centros de Arbor Health, le recomendamos que se comunique con un representante de cuentas de los pacientes para conocer las opciones de ayuda para el pago de esos gastos.

¿Qué está cubierto?

Ofrecemos asistencia financiera a pacientes elegibles con una escala de tarifas gradual para servicios médicos necesarios. Nuestros descuentos oscilan entre el 15 % y el 100 % con base en el Índice federal de pobreza.

¿Cómo se solicita?

Un paciente que busca asistencia financiera debe presentar la documentación de respaldo descrita en el formulario de «solicitud de asistencia financiera», a menos que el LCHD N° 1 indique algo diferente. El formulario de solicitud se obtiene de una de las siguientes maneras: en línea, a través de nuestro sitio web; llamando al número que figura más adelante, o acudiendo a nuestro hospital o clínicas.

Otra asistencia:

Si usted no tiene cobertura de seguro de salud, puede calificar para otros programas del gobierno y de la comunidad. Podemos ayudarlo a investigar y solicitar otros programas que puedan estar disponibles para usted. Otros programas pueden incluir: Medicare, Medicaid o Asuntos de Veteranos.

Limitaciones en los aranceles:

El LCHD N° 1 usa la fórmula de «Importes facturados habitualmente» (AGB, por su sigla en inglés) para determinar el valor de los descuentos que ofrecerá a los pacientes no asegurados que, de lo contrario, no califican para recibir asistencia financiera. Los AGB se determinan analizando todos los reclamos facturados y pagados del año anterior. El importe neto del pago se usa para determinar el valor promedio del pago por clase financiera. La intención es no cobrarles a los pacientes que pagan sus propias facturas más de lo que esperamos cobrar de una compañía de seguros. Este descuento (501r) se aplica a los servicios médicos emergentes y necesarios de las Clínicas de Arbor Health y del Hospital Arbor Health Morton. El cálculo de los AGB se usa para determinar el descuento para el año calendario siguiente.

Pagos:

Una vez que su compañía de seguros procese su reclamo, cualquier saldo que usted adeude deberá cancelarse en un plazo de treinta días, a menos que se haya hecho un arreglo diferente. Aceptamos efectivo, cheques, pagos en línea o tarjetas de crédito. Si desea establecer un plan de pago, debe llamar al número que figura más adelante. Los saldos impagos se podrán asignar a una agencia de cobranzas externa y están sujetos a multas, penalidades y aranceles adicionales. Si desea una copia de nuestra política de cobranza, llame a Cuentas de los pacientes, al 360-496-3707.

Atención de emergencia:

El LCHD cuenta con un departamento de emergencias especializado que ofrece atención de afecciones médicas de emergencia (según la definición de la Ley de Tratamiento Médico de Emergencias y Partos) sin discriminación, independientemente de su capacidad para pagar por los servicios.

Listado de prestadores/entidades no cubiertas

PHYSICIANS or MEDICAL GROUPS COVERED

PHYSICIANS or MEDICAL GROUPS NOT COVERED

All Arbor Health clinic providers (physicians, physician assistance, nurse practitioners and licensed clinical Social workers.

  • Arbor Health Massage Therapist
  • Arbor Health Anesthesiologist/CRNA’s
  • Providence Hospital and Affiliates
  • Arbor Health Emergency Room providers
  • South Sound Radiology Group
  • Arbor Health Surgery Providers
  • LabCorp
  • Arbor Health Method II Providers
  • PeaceHealth
  • Arbor Health Physical Therapist, Occupational Therapist and Speech Therapy
  • St. Joseph’s Hospital and Affiliates
  • Arbor Health Locum Tenens
  • Assured Hospice and Home Health
  • Arbor Health Contract Providers
  • Non-Arbor Health Providers
  • Arbor Health Respiratory Therapist
  • Radia Inc.
  • All Arbor Health Clinics; Morton Clinic, Mossyrock Clinic, Randle Clinic and Specialty Clinic.
  • Pacific Medical Group-DME

Definiciones

Atención Médica Benéfica/Asistencia Financiera

Servicios Médicos Necesarios o Atención de Emergencia prestados sin cargo o a una tarifa reducida a pacientes que tienen pocos o ningún ingreso y que de lo contrario no podrían pagar por su tratamiento. La Atención Médica Benéfica también se denomina atención sin cargo y asistencia financiera.

Atención de indigentes

Según la Sección 413.89 de 42 CFR, Medicare debe reintegrar los importes deducibles y el coaseguro de beneficiarios de Medicare que permanezcan impagos después de que el prestador haya hecho un esfuerzo de cobranza razonable. Esta disposición es para garantizar el pago de los costos cubiertos de beneficiarios de Medicare. Si se presume que el paciente es indigente, el prestador debe facturar a Medicaid (si califica) antes de reclamar cualquier deducible o coaseguro impago. Además, si no tiene ninguna otra cobertura y sus ingresos son limitados, el paciente también puede calificar para la atención de indigentes. Las deudas se ajustan como deudas incobrables de Medicare y no se consideran un ajuste contractual.

Reglamento 501(r) del IRS

La Ley de Atención Accesible impone cuatro requisitos para los hospitales y sistemas de salud sin fines de lucro a los efectos de mantener su situación de exención impositiva y de actividad no lucrativa. Tres de estos requisitos están directamente relacionados con las operaciones del ciclo de ingresos, incluida la Política de Asistencia Financiera (FAP), la determinación de límites de aranceles (AGB) para pacientes que califiquen para la FAP, y los esfuerzos razonables para determinar la elegibilidad para la FAP antes de iniciar medidas extraordinarias de cobranza contra un individuo.

360-496-5328 or 800-339-0791