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PATIENT
FINANCIAL ASSISTANCE
We're
Here to Serve Our Community
Overview
Options for Financial Assistance
What is Covered
Government and Community
Programs
Financial Assistance
Program
Discounts for Patients Who Don't Qualify for Financial Assistance
Payment Plan Option
We're
Here to Serve Our Community:
Free Care - For
Patients Without Means
Mercy Medical Center
is committed to caring for all our community members, regardless
of their ability to pay. Our generous charity care policy is just
one living example of Mercy's mission and service to the poor, uninsured,
and underinsured.
Contact
Financial Account Counselors:
541-677-2307
541-677-3537
Overview
The mission
of Mercy Medical Center and Catholic Health Initiatives is to nurture
the healing ministry of the Church by bringing it new life and viability
in the 21st century. Fidelity to Gospel urges us to emphasize human
dignity and social justice as we move toward the creation of healthier
communities.
In light of
our mission, Mercy Medical Center offers financial assistance to
help with medically necessary treatment and procedures, whether
it is by absorbing part of the cost based on need, or helping to
identify community or governmental programs to meet your needs.
This program does not cover cosmetic surgical packages. Financial
assistance is specific to each patient. Guidelines are used to determine
eligibility based on family income.
In some instances
patients may be presumed to be eligible for financial assistance
based on the completion of a short questionnaire. New admissions
or re-admissions will be screened for changes in eligibility for
financial assistance. Mercy Medical Center’s decision to provide
financial assistance in no way affects the responsible party’s
financial obligations to physician or other health care providers.
Mercy’s
financial assistance is secondary to all other financial resources
available to patients. Mercy’s Patient Financial Counselors
are here to help and are available to explain paperwork and answer
your questions. If you feel this financial obligation may be a hardship
for you and you wish to apply for financial assistance, please print
this application and complete, or call one
of our Patient Financial Counselors:
541-677-2307
541-677-3537
Applications
are also available at Mercy’s main Admission’s desk
and at Mercy’s Business Office.
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Options
for Financial Assistance
Applications
for financial assistance are available online: Click
here (311KB PDF) to print an application. Please contact
a Patient Financial Counselor for help filling out the form and
completing the application process.
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What
Is Covered
Mercy’s
financial assistance is available to cover medically necessary services
provided by Mercy Medical Center in Roseburg, Oregon, including
hospital care. Medically necessary is any procedure that meets the
guidelines set forth by the Oregon Health Plan. The Oregon Health
Plan was developed with extensive citizen input that created a prioritized
list of health conditions and treatments. The list is maintained
and updated by the Oregon Health Services Commission. The conditions
and treatments are ranked for importance to health, and are funded
by the State for patients covered under the Oregon Health Plan.
This list serves as a model for basic and necessary health care
for Oregon’s citizens. Basic and necessary health care does
not cover all possible procedures.
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Government
and Community Programs
Mercy cannot
meet the needs of all patients who are unable to cover their medical
bills. For this reason, patients without insurance coverage must
take advantage of programs for assistance for which they qualify.
This helps ensure that Mercy’s limited resources will be available
to patients who don’t qualify for other financial help.
One of Mercy’s
Patient Financial Counselors will work with you to determine your
eligibility for government and community programs that may help
cover medical expenses. The financial counselor is available to
assist you in applying for these programs.
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Financial
Assistance Program
Mercy’s
Financial Assistance program has been designed to help patients
who cannot afford or qualify for health insurance, or who have very
limited financial resources, or who have incurred sizable medical
bills that are beyond their ability to pay.
Any patient
can apply to receive financial assistance with medical bills. Eligibility
will be determined based on your household income, monthly expenses,
available assets, current financial obligations, outstanding medical
bills, ongoing medical expenses and availability of insurance coverage.
You’ll be asked to provide this information on a financial
questionnaire.
Examples of
documentation that will be required are rent receipts, utility receipts,
current Federal 1040 taxes or monthly bank statements.
Mercy utilizes a sliding scale to provide up to a full discount
of charges for patients with no third-party insurance, and up to
a full waiver of co-payments after third-party insurance proceeds,
based on financial need. The following points are taken into consideration:
The standards
of eligibility for the application of charity discounts must consider
assets as well as income. Eligibility shall be based on 130% of
the annually updated HUD Very-Low Income Guidelines. These HUD guidelines
take into consideration family incomes that do not exceed 50% of
the median family income for a geographic area, and shall utilize
a sliding scale approach based on income and family size. The guidelines
are available at the HUD Office of Policy Development and Research
website at http://www.huduser.org/datasets/il.html.
Data may be downloaded in PDF, Word, or Excel file formats.
When circumstances
indicate the presence of severe financial hardship or personal loss,
those patients with few resources and a high number of dependents
shall receive higher levels of financial assistance. This shall
be determined by the use of a sliding scale based on income and
family size (as noted in Attachment C of the policy). The maximum
income level eligibility as defined on the sliding scale represents
150% of the new base, effectively 195% of the HUD Very-Low Income
Guidelines.
To apply for the Financial Assistance Program, you will need to
complete a financial questionnaire. To obtain this form, please
contact a financial counselor or business office representative,
or print one online
application. A financial counselor is available
to help you with filling out the financial questionnaire and completing
the entire application process.
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Discounts for Patients Who Don't Qualify for Financial Assistance
For patients who do not qualify for our Financial Assistance Program,
Mercy Medical Center extends a deeply discounted rate plan for medically
necessary services. Each year, Mercy reviews and establishes an
average managed care contractual allowance and applies this discount
to all uninsured patients who are eligible. To determine your eligibility,
the amount of your discount and the terms of your payment, please
contact a Mercy Business Office representative.
Payment
Plan Options
After all available
health insurance coverage, discounts and financial assistance have
been applied to a medical bill, there still may be a remaining balance.
Although this balance is your responsibility to pay, a financial
counselor or business office representative can work with you to
set up a payment plan.
Discounts.pdf
Uninsured-Underinsured Pt1
Uninsured-Underinsured Pt2
Uninsured-Underinsured Pt3
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