This policy identifies the circumstances under which South Shore Hospital will extend medical care free of charge or at a discount commensurate with the patient’s ability to pay. The necessity for medical treatment of all patients will be based upon clinical judgment without regard to the financial status of the patient.
AGB – amounts generally billed for emergency or medically necessary care to individuals who have insurance coverage.
Bad Debt Expense – health care services provided that are expected to result in the generation of payment of services, but due to the patients’ unwillingness to meet their financial obligation, resulted in non-collection of those services.
Charity (Free) or Discounted Care – health care services provided that are not expected to result in the generation of payment in full, in accordance with procedures established in this policy. This does not include contractual allowance amounts between hospital gross charges and contracted third party reimbursement rates.
ECAs – extraordinary collection actions are actions taken by South Shore Hospital against an individual related to obtaining payment of a bill for care covered under South Shore Hospital’s FAP that require a legal or judicial process or involve selling an individual’s debt to another party, or reporting adverse information about the individual to consumer credit reporting agencies or credit bureaus.
FAP – financial assistance policy.
FAP-Eligible Individual – an individual eligible for financial assistance under South Shore Hospital’s FAP (without regard to whether the individual has applied for assistance under the FAP).
Insurance Payments – health care services that were expected to result in the generation of payment of services from Medicare, Medicaid, Blue Cross, HMO’s, PPO’s and any other valid and qualifying insurance that the patient possesses. This includes any valid supplemental insurance to meet deductible and co-insurance payments required by insurance providers described above.
Patients without Insurance (Uninsured Patients) – patients requiring medically necessary services who are not covered by or eligible for Medicare, Medicaid HMO’s, PPO’s or other third party payers at the time healthcare services are provided.
Presumptive Charity Care – health care services to uninsured patients that are not expected to result in payment and no Financial Assistance Application is completed.
It is the policy of South Shore Hospital to provide quality medical health care to all persons regardless of race, creed, sex, national origin, handicap, age or the ability to pay. South Shore Hospital recognizes that not all individuals possess the ability or means to purchase essential medical services, and, further, that our mission is to serve the community with respect to providing healthcare services and healthcare education. Therefore, in keeping with the South Shore Hospital’s commitment to serve all members of the community, charity and/or subsidized care will be considered where the need and/or an inability to pay are identified.
Charity and/or subsidized care includes medical services provided to uninsured non-governmental patients, indigent government program patients and/or other low income, underinsured patients. South Shore Hospital will also consider cases of medical need in catastrophic cases where income or assets would otherwise be considered too high to qualify for assistance. Each patient will be reviewed based upon the standards set forth within this policy. Charity and/or subsidized care will be granted solely for the benefit of the patient and his/her family and is not intended to relieve the patient of liability for payment to other third parties.
Income Level Discount from Gross Charges
200% FPG or below 100% Discount
Above 200%; at or below 300% FPG 80% Discount
Above 300%; at or below 400% FPG 65% Discount
Above 400% FPG Patient to pay balance
(unless patient qualifies under
the Illinois Hospital Uninsured
Patient Discount Act)
To insure that the determination of charity or discounted care receives appropriate levels of considerations the following approval guidelines and levels will be followed:
Charity or Discounted Care
$1 – $30,000 Director, PFS
$30,000 – and above CFO
Following the determination of FAP-eligibility, a FAP-eligible individual will not be charged more for emergency or other medically necessary care than the amounts generally billed (AGB) to individuals who have insurance covering such care. The methodology used by South Shore Hospital to calculate AGB is the Look-back Method. Members of the public may readily obtain the current AGB percentage and a description of how the percentage was calculated by contacting the South Shore Hospital Patient Account Department at 773-356-5219.
The actions that South Shore Hospital may take in the event of nonpayment are described in a separate Billing and Collection Policy. Members of the public may readily obtain a free copy of that policy by contacting the South Shore Hospital Patient Account Department at 773-356-5217.
“You may be eligible for financial assistance under the terms and conditions the hospital offers to qualified patients. For more information contact South Shore Hospital Financial Counselors at 773-356-5212.”
In order to quantify the level of charity care, a general ledger report will be available to document the total value of all charity or discounted care. This report will be available for inspection by any government agency requiring levels of charity or discounted care as part of South Shore Hospital maintaining the exemption from federal, state, or local taxes.