Bronson Corporate Financial Assistance Policy

Purpose

Bronson Healthcare Group (Bronson) hospital facilities (Bronson Battle Creek Hospital, Bronson Lakeview Hospital, Bronson Methodist Hospital and Bronson South Haven Hospital, collectively, “the Hospitals”) know that not all individuals are able pay for their healthcare services. In keeping with their tax-exempt mission and commitment to the surrounding communities, Bronson and its employed physicians strive to ensure that the financial ability of individuals does not prevent them from seeking or receiving medically necessary care. The Hospitals each recognize their responsibility to offer care for persons in need. They provide and promote access to emergency or medically necessary services regardless of the ability to pay

Policy

The Bronson Financial Assistance Policy (“FAP”) ensures that financial assistance for medical services is provided to eligible individuals. Information that is shared when making an application is confidential regardless of the decision on the application. People who apply will be treated with respect, dignity and compassion. Patients are expected to cooperate with the Hospital’s procedures for obtaining financial assistance. Patients are expected to contribute to the cost of their care based on their ability to pay. This Policy requires requested information from the patient in order to decide on eligibility for assistance. This policy would cover a patient’s out-of-pocket liabilities including, but not limited to, coinsurance, deductible, benefit maximum, and copayment amounts.

Bronson reserves the right to change this Policy for any reason. The most common reason for changes to the policy are due to government regulation changes.

This Policy addresses:

• Eligibility criteria for financial assistance
• Ways to apply for financial assistance
• Limitations on amounts patients will have to pay if they qualify for financial assistance
• Efforts to publicize the financial assistance policy

Definitions

Amounts Generally Billed (AGB)

IRS term that means the amounts generally billed for care to people who have insurance.

Family

A group of two or more people who live together and who are related by birth, marriage, or adoption. If the patient claims someone as a dependent on their income tax return, they may be considered a dependent on a financial assistance application.

Family Income

Bronson uses the Census Bureau definition of family income. It considers the following sources as income in relation to the federal poverty guidelines:

• Earnings from a job, unemployment, workers' compensation, Social Security, Supplemental Security Income, public assistance, veterans' payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and any income from other sources.

Federal Poverty Level (FPL)

A measure of income issued every year by the Department of Health and Human Services. Federal Poverty Levels are used to determine eligibility for programs and benefits such as Medicaid.

Financial Assistance

A program designed to help a patient who is not able to pay for medical services. The services must be medically necessary. It is based on meeting the income guidelines and eligibility criteria in this policy.

Medical Necessity

Emergency medical services for conditions which would cause harm to the patient’s health if not treated. This is decided by a qualified healthcare provider.

Protected Assets

Protected assets are property or income that are not considered when determining an individual’s qualification for financial assistance under this policy. They are not assumed to be available for use towards an individual’s medical expenses.

Uninsured

Also referred to as “self-pay”, patients that have no insurance coverage to cover the cost of medical services.

Underinsured

The patient has some insurance but still has out-of-pocket expenses that exceed his/her ability to pay.

Eligibility

Patients that are uninsured, insured, or underinsured, and unable to pay for their medically necessary care, can be considered for financial assistance. Patients are eligible to receive financial assistance if they meet the requirements described in this Policy. Eligible services are those that are medically necessary, including emergency medical services provided in an emergency room setting, and services for conditions which, if not treated, would cause harm. A listing of providers that participate with this Policy can be found on the Bronson website at: https://www.bronsonhealth.com/app/files/public/3634/501R-Financial-Assistance-Participants.pdf.

Financial Assistance Eligibility Scale – Bronson Battle Creek Hospital, Bronson Lakeview Hospital, Bronson Methodist Hospital, and Bronson South Haven Hospital

2024 Federal Poverty Level (FPL) Guidelines Reference

Catastrophic circumstances may be considered if both of the following situations are met:

1. The patient applies and qualifies for financial assistance within the current FPL discount scale with less than a 100% discount and
2. A single admission results in at least $10,000 in patient responsibility. If both conditions are met, the account will be reviewed for a 100% discount.

Catastrophic circumstances may be considered if the following situation applies:

1. Patients who have accumulated a large medical debt as a result of a catastrophic medical event that resulted in current out-of-pocket expenses that exceeded 25% of their gross annual household income.

Any determination, approval or denial, for financial assistance is subject to change if it is discovered that information was withheld, or circumstances changed at any time within the eligibility period. If information provided is later found to be inaccurate, Bronson has the right to ask the patient for payment for services received.

Applying for Financial Assistance

To apply for financial assistance, a patient must submit a signed and complete Bronson Financial Assistance Application. Failure to provide the required information or return necessary documentation can result in denial of your request. If approved, financial assistance will be valid for 240 days prior to the receipt of the signed and complete application and for 6 months after. Accordingly, if a patient has qualified for financial assistance within the last 6 months and the patient’s financial circumstances have not changed, the patient will be deemed to have qualified for financial assistance with respect to additional emergency or medically necessary care, without having to submit a new financial assistance application. This Policy applies to patients who reside in Michigan, Ohio, Illinois or Indiana. The service must be considered medically necessary.

If uninsured, it is required to apply for Medicaid as part of the application process. Bronson Financial Counselors can help uninsured patients and their families apply for Medicaid.

You may also apply for financial assistance before or during your receipt of medical services. Patients that have health insurance will not be automatically screened for financial assistance. The underinsured are eligible to apply for financial assistance, if approved, the underinsured patient will receive the same financial assistance percentage as the uninsured. Any member of the Bronson staff, including physicians, nurses, financial counselors, social workers, case managers, and chaplains can refer a patient to apply for financial assistance.

The patient, or responsible party, is obligated to provide necessary information in order for Bronson to make a decision. The ability to pay, including income and assets for the patient and their spouse and family, will be taken into account. In addition to completing the Bronson Financial Assistance Application, the following documents are needed:

• If employed, last month of pay stub(s) showing YTD (Year to Date) gross income, or a letter from the employer on company letterhead that verifies the YTD gross income, and/or prior year’s personal tax return. A letter of support as described below is acceptable in lieu of a tax return if the individual was unemployed the prior year and has no return to provide.
• If self-employed, prior year’s personal tax return and a tax return for the individual’s business including all schedules.
• If unemployed, last 2 unemployment check pay stubs showing YTD gross income or a print-out from the state website showing YTD gross income. If you are not eligible for unemployment benefits, a letter documenting that is needed.
• If receiving Social Security Benefits, a copy of letter showing the monthly benefit amount.
• Documentation of additional income sources such as child support, pension, rental income, or any other source of income must be included.
• If there is no income received, a letter of support from individual assisting patient to meet their basic needs is required.
• If the patient is uninsured, the patient and their family must apply for Medicaid and have a response before the Financial Assistance Application will be reviewed. The Medicaid decision must be included with the application.
• Current photo ID and insurance card if applicable. Accepted forms include Kalamazoo County ID, VOCES ID card, or Consular card. If an individual has no photo ID, Bronson will follow the State of Michigan requirements for proving residency..

Bronson has the right to ask for additional documentation before making a final financial assistance determination. This may include bank statements, proof of assets, prior year tax return, proof of residency and disclosure of claims and/or income from personal injury and/or accident-related claims.

If the application is incomplete, the patient will be asked to provide the additional information.

An evaluation will be made based on all application data, dependency status, and supporting documentation. Bronson Patient Financial Assistance staff will make an eligibility decision within 30 business days following the receipt of the completed application and documentation. Bronson will notify patients of the determination and the reasons for the decision.

While financial assistance should be made in accordance to Bronson’s policy, it is recognized that occasionally there will be a need for approving additional support to patients based upon their individual circumstances. Such considerations will be reviewed and approved by the VP of Revenue Cycle and/or Chief Financial Officer.

Presumptive Eligibility

Presumptive methods may be used to determine financial assistance eligibility. Methods may include using data from an application that was submitted in the past, publicly available data sources that provide information on the patient’s ability to pay (such as credit scoring), or other program enrollment resources. Bronson Healthcare Group will contract with a third party vendor to conduct a review of patient information to assess financial need. This includes segmentation score and credit score. No financial assistance application is required to qualify for presumptive eligibility. In the case that presumptive eligibility is used and results in less than a 100% discount, patients, or their responsible party, will be made aware of the discounts available to them

Patients who have not submitted a completed a financial assistance application, but who is subject to one or more of the following criteria will be reviewed for presumptive eligibility:

• Homeless
• Living at an address that indicated subsidized housing
• Deceased patients with no known estate
• Receiving assistance in a state or federally funded program (Medicaid)
• Denied over income for Medicaid
• Medicare part A coverage only
• Approved for Bronson Financial Assistance in previous 6-month period

Based on the agreement in place with Family Health Services and Grace Health, financial assistance determinations previously made by the named facilities in accordance with their own eligibility criteria may be presumed valid for medically necessary services provided at the Hospitals, and financial assistance may be granted.

Transitional Assistance

Financial assistance may be available to assist insured, uninsured and underinsured patients whose financial responsibility has increased substantially due to a change in the place where the services are given. A change in setting may arise when a site that was formerly a private physician office is now a hospital outpatient department. If a patient received services before and after the change in setting, a discount may be available for services received in the change. On request, Bronson Patient Financial Assistance staff will determine the amount of transitional assistance. The patient may need to complete the Financial Assistance application or provide evidence that the increase in the amount owed because of the change in setting creates a financial hardship. Transitional assistance is not available for more than one year following the date of the change in setting.

Exclusions

The following situations or services will not be considered for financial assistance eligibility:

• Patients who have another available insurance coverage option, such as Medicaid, automobile, worker’s compensation, and do not take the necessary steps to get the coverage:
  • Patients, and their family, who decline to apply for Medicaid under the state guidelines.
  • The patient was injured as a direct result of an accident involving his/her motor vehicle and who did not have the required insurance on the motor vehicle.
  • Self-employed patients who do not have worker’s compensation insurance and are injured on the job (self-employed LLC).
• Patients with insurance who do not follow the insurance company’s rules for precertification, coordination of benefits (COB) or who seek treatment at a Bronson facility when Bronson is not the preferred provider for the insurance plan. This does not apply to emergency situations.
  • Managed Medicaid plans and Medicare Advantage plans are eligible despite no participation.
• The patient and/or family shows evidence of at least $50,000 in checking and/or savings.
  • With exception for the following protected assets:
    • Primary personal residence
    • IRA, 401K, cash value retirement plans/pensions
    • College savings plan
• Charges as a result of collection agency referral. Such as court costs, filing fees, interest, and/or attorney fees.

EMTALA

Limitations on Patient Financial Responsibility

A patient who is eligible for financial assistance will not be responsible for more than amounts generally billed (AGB) for emergency and other medically necessary care. Bronson Healthcare Group utlizes the look-back method to determine the amounts generally billed (AGB) in a prior 12-month period.

The AGB for the Hospitals are re-calculated on at least an annual basis. Updates will be reflected in this Policy. Additional information on the specific AGB percentages or calculation methods can be obtained free of charge by calling or sending a request in writing to the Bronson Billing Department (see Appendix A for contact information)

In accordance with Michigan Law, for uninsured patients with family income up to 250% of the federal poverty level, the maximum payment required is 115% of the Medicare rate for services. To apply for this discount, the family must complete the Bronson Financial Assistance Application and submit with last year’s complete tax return.

Publication

The following measures are taken to make reasonable efforts to inform and publicize the availability of Bronson’s FAP to patients and the public in accordance with Section 501(r) requirements:

• Information is displayed in the emergency, admitting, and financial counseling departments’ waiting areas referencing the availability of financial assistance.
• The Bronson Financial Assistance Policy Summary is offered or provided as part of the discharge or intake process for patients receiving services at the Hospitals.
• Free paper copies of financial assistance documents (Bronson Financial Assistance Policy, Bronson Financial Assistance Application and the Bronson Financial Assistance Policy Summary) can be obtained from the emergency, admitting, outpatient registration and financial counseling departments within the Hospitals. They can also be requested by mail from the Bronson Billing Department (see Appendix A for contact information).
• Reference to the availability of financial assistance is included on each of Bronson’s billing statements. Notification of Extraordinary Collection Activity (ECAs) that Bronson or a collection agency may intend to take will be made at least 30 days before action is taken.
• The Bronson Financial Assistance Policy, Bronson Financial Assistance Application and Bronson Financial Assistance Policy Summary are posted on Bronson’s website in English, Spanish, Arabic, and Burmese. (https://www.bronsonhealth.com/financialassistance)
• Patient Financial Counselors, Billing staff or the Collection agency will give oral notification of the availability of financial assistance.

APPENDIX A

Bronson Financial Assistance Website

Visit our website at https://www.bronsonhealth.com/financialassistance for more information including contact information as well as free and printable copies of the Financial Assistance Summary, Bronson Financial Assistance Policy and Bronson Financial Assistance Application in English, Spanish, Arabic and Burmese.

Bronson Billing Department

1-800-699-6117 Monday – Friday 8:30 a.m.-5:30 p.m.

Bronson Financial Assistance Mailing Address

Bronson Healthcare Group
Patient Accounting Attn: SP
601 John St - Box J
Kalamazoo, MI 49007-5341

Bronson Financial Counseling Departments

Patients needing financial assistance while at the hospital or who need help completing the application, can meet with Financial Counselors on-site. Hours: Monday – Friday 8:00 a.m. – 4:30 p.m.

• Bronson Battle Creek Hospital – (269) 245-8124
  300 North Avenue, Battle Creek, MI
  Financial Counselors are located in the Registration Department to the right, past the Greeter Desk. Enter through the Outpatient Center entrance, parking lot entrance off Emmett Street.

• Bronson Lakeview Hospital – (269) 657-1532
  408 Hazen Street, Paw Paw, MI
  Financial Counselors are located on 1st Floor, North Entrance in the Outpatient Registration area.

• Bronson Methodist Hospital – (269) 341-6120
  601 John Street, Kalamazoo, MI
  Financial Counselors are located in the Financial Services office on the 1st Floor Medical Office Pavilion behind the main Information Desk.

• Bronson South Haven Hospital – (269) 639-2865
  955 South Bailey Avenue, South Haven, MI
  

  Financial Counselors are located in the Cashier’s Office on the 1st floor. Please see registration or HIM window.