FAQs for PeaceHealth Financial Assistance
What is Financial Assistance?
Financial Assistance is the PeaceHealth program that provides medically necessary and some preventive services at a reduced cost or without charge when payment cannot be obtained through all other available financial resources. It is limited to patients at PeaceHealth facilities.
This policy allows us to manage our financial health with our mission of providing care to all in need. It ensures that patients receive fair and equal financial treatment across PeaceHealth.
Is Financial Assistance a new policy?
Our policy and practices related to charity care are known as Financial Assistance, which consists of two programs:
- Bridge, for the uninsured
- Pathways, for the insured/underinsured.
Financial Assistance standardizes policy and practices across our entire system.
Caregivers in financial counseling support Financial Assistance Policy by working with patients to ensure their portion of their bill is financially secured.
Why do we call it Financial Assistance instead of charity care?
In the spirit of our core value of “Respecting Individual Human Dignity and Worth,” PeaceHealth avoids using “charity,” which can carry negative connotations.
What types of services are covered?
Financial Assistance is granted for medically necessary services.
“Medical necessity” refers to care deemed in the opinion of the treating physician/clinician to be needed in:
- establishing a diagnosis;
- providing palliative, curative or restorative treatment for physical, behavioral and/or mental health conditions;
- assisting the individual to achieve goals that the care team has established as related to functional capacity.
Is Financial Assistance available for non-PeaceHealth provider fees and services?
No, Financial Assistance is granted only for financial obligations related to PeaceHealth care. It is not available for the services of physicians or other health care.
Where is Financial Assistance available?
The service area is the county or local area in which a PeaceHealth facility is located.
What if the patient lives outside of a PeaceHealth county/service area?
Patients who live outside PeaceHealth’s county/service area are eligible for Financial Assistance when they need emergent care.
What is the first step in determining eligibility?
Anyone seeking Financial Assistance will be screened using PeaceHealth system standards, as listed in the Financial Counseling Training Manual. Patients who meet criteria complete an application, which must receive formal approval.
Who can initiate this process?
Anyone—a patient, physician, family member, community and/or religious group, or hospital personnel—can initiate this process.
When can a patient apply?
A patient may apply at any time—before, during or after treatment.
How does a patient apply?
There are several ways to apply. Instructions and the application are on PeaceHealth.org
. and also may be obtained from a financial counselor or customer service representative.
Is the process confidential?
All information is kept confidential.
Is the amount of care a determining factor?
No, the process is the same for both eligibility and approval, regardless of the amount of the patient’s balance.
How is payment addressed while this process is underway?
During this time period, pending final eligibility determination, PeaceHealth will not initiate collection efforts or requests for deposits provided that the responsible party is cooperative with PeaceHealth’s efforts to get payment from other sources.
How is eligibility determined?
Each situation will be reviewed independently. These guidelines help determine eligibility:
- annual household income
- number of people in the household
- securable assets (excluding primary residence, family’s primary mode of transportation and retirement accounts)
- special medical costs
- living expenses
- credit history
- existing debt
- other indicators of ability to pay
Financial Assistance is granted to all applicants whose Adjusted Gross Income (AGI) falls at or below 200 percent of the current Federal Poverty Levels. Assets are not considered for these applicants.
Financial Assistance will be awarded to applicants whose Adjusted Gross Income is between 201 and 400 percent of the current Federal Poverty Level (FPL). Assets and reasonable living expenses may also be considered when determining eligibility for Financial Assistance for these applicants.
Federal Poverty Percentages
|0 to 200%
|201 to 250%
|251 to 300%
|301 to 350%
|351 to 400%
When will a patient be notified of the decision?
Written notice of assistance determinations will be mailed within 14 calendar days from receipt of the completed application. The notification includes the level of reduction and payment arrangements consistent with ability to pay. Denials include the reason for denial and instructions for seeking an appeal or a reconsideration.
What types of circumstances would not receive approval?
Financial assistance is not granted for procedures that are not medically necessary or when insurance or government programs are available to the patient.).
Is there a way to appeal an eligibility decision?
Yes, the person responsible for the financial obligation may appeal by submitting additional information to the System Director of Hospital Revenue Cycle.
Are handouts available?
Brochures are available at all PeaceHealth facilities in areas such as registration, check-in, exam rooms and cashier stations, and from Financial Counseling Services or Customer Service.
Who can a patient talk to?
Customer Service Representatives at 800-873-8253 are happy to help.