Financial and Insurance Assistance
Glens Falls Hospital will make Patient Financial Assistance available to qualified patients. Glens Falls Hospital recognizes that there are times when patients in need of care will be unable to pay for the needed health care services provided. It is the policy of Glens Falls Hospital to provide and promote a consistent methodology for extending financial assistance to qualified patients in order to facilitate payment for hospital services.
A patient’s eligibility for Patient Financial Assistance will be based upon the size of the applicant’s family and is limited to those families whose income is less than or equal to 3.3 times (330%) of the current poverty level income guidelines as determined by the Community Services Administration. In addition, applicants must demonstrate that they are unable to pay for the services rendered. Glens Falls Hospital will then use the attached guidelines to determine the appropriate level of financial assistance.
DESCRIPTION OF SERVICE AREA
Glens Falls Hospital will extend financial assistance to all eligible patients including patients whose residency falls outside our primary service area within New York State as well as patients whose residency is outside New York State.
INABILITY TO PAY
Eligible patients are requested to provide income verification every six months. Once qualified, the Hospital will use income information to determine levels of financial assistance for each six-month period. Patients must demonstrate that they are not eligible for Medicaid. The Hospital will provide assistance in obtaining Medicaid coverage, if required documents are provided to the Hospital in a timely manner.
Patient Financial Assistance funds will be utilized for all services rendered by Glens Falls Hospital, including Adirondack Medical Services, with the exception of cosmetic procedures and hearing aids. Charges from private Physicians who provide services at the hospital are not covered. (example: Radiologist/Pathologists/Anesthesiologists)
Patients seeking access to the Patient Financial
Assistance Program will complete an application
under the guidance of a Patient Financial Services
representative. During this process, the
determination of eligibility will be made contingent
upon the patient producing income verification
(tax returns) and a Medicaid denial, if applicable.
The Patient Financial Services Department will render a decision within ten (10) business days of receipt of all necessary patient documentation. Any application will be considered withdrawn if all requested documentation is not presented within twenty (20) days of the request. If the documentation used to prove eligibility is found to be fraudulent, any Patient Assistance awarded will be revoked and all normal collection efforts will be pursued.
ACCEPTABLE INCOME VERIFICATION
1. Most recent income tax return (Federal
Tax Return will be used to determine
family size). 2. Self-Employed individual’s income
calculation will be based on adjusted gross
income reported on IRS tax form – 1040.
3. Other income documentation (example:
SSI, SSD or pension statement)
Patient Financial Assistance will only be applied
after all insurance coverage has been exhausted
or for uninsured self-pay patients. A Patient
Financial Assistance application must be made
within 90 days after receipt of the initial bill
from Glens Falls Hospital.
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