What is "uncompensated health care"?
"Uncompensated health care" usually refers to charity care (also known as community care or indigent care) and bad debt. Charity care is care for which a hospital does not charge because it has been determined that the patient cannot afford to pay. Bad debt comes from care for which payment is expected but the hospital is unable to collect. The level of charity care for a particular hospital may reflect a charitable mission of the hospital, or may reflect the socioeconomic conditions of the patients and the service area of the hospital. A low level of charity care does not necessarily mean a lack of commitment to serve the community.
Who is eligible for charity care?
It depends on the hospital Hospitals usually limit these programs to people not eligible for government medical assistance programs, those unable to pay their medical bills, or those with limited financial resources. You should check with the patient services department at your hospital to find out about your eligibility.
How do hospitals check on eligibility?
Nearly every hospital has a procedure to determine and verify the income information given by persons applying for uncompensated health care services.
The following is a summary of the steps that hospitals generally use to determine eligibility or verify applicant information:
- Hospital identifies any uninsured, underinsured, or self-pay patients.
- Patient completes application/determination of eligibility form.
- Patient completes financial statement that includes income, assets, and liabilities. Patient supplies documentation of resources (e.g., W-2 pay stubs, tax forms) and outstanding obligations (e.g., bank statements, loan documents).
- Hospital considers federal poverty guidelines and family size.
- Hospital verifies third-party coverage, if indicated.
- Hospital staff person interviews patient to assess if the patient: has the ability to pay in full, has the ability to pay reasonable monthly installments, or qualifies for General Relief.
- Hospital attempts to secure federal, state, or local funding, if appropriate.
- After the hospital makes an initial determination of insufficient funds, income, and health care benefits, the claim becomes eligible for final review, often by a committee comprising administrative, business office, social services, and nursing staff.
How do hospitals let patients know about charity care?
Hospitals may give information and applications for charity care:
- At registration
- In the emergency room
- At financial services offices
- In a patient's admission packet
- With the bill
Some hospitals offer individual counseling at the time of pre-admission or during the collection process. Signs may be posted in English or other languages, explaining available charity care services. Hospitals also publish annual notices in local or area newspapers describing charity care programs.
What is the Hill-Burton program?
Between 1946 and 1974, a number of Wisconsin hospitals participated in the Hill-Burton program, which provided federal funds to assist in the construction or renovation of facilities. In return for funding, the hospitals agreed to provide a reasonable amount of care without charge or at reduced rates to patients who could not afford health care.
There are a few Wisconsin hospitals that still have Hill-Burton obligations. Hospitals with Hill-Burton obligations must follow federal procedures to determine patient eligibility. More information on the Hill-Burton program and answers to frequently asked questions about the Hill-Burton program are available online from the U.S. Department of Health and Human Services or by calling the Hill-Burton hotline at 1-800-638-0742. The hotline is available 24 hours a day.
Can a hospital turn me away if I cannot pay?
Under the Emergency Medical Treatment and Active Labor Act (EMTALA), hospitals receiving Medicare funds (which includes most U.S. hospitals) must screen anyone who comes to the emergency room and requests treatment. If the screening confirms that the person has an emergency medical condition, the hospital must provide treatment and cannot transfer you to a charity or county hospital until your condition has been stabilized. Women in active labor must be treated until the baby and placenta have been delivered.
What are some of the limits of EMTALA?
- EMTALA does not protect you from bills or collection efforts after the services have been provided.
- EMTALA does not obligate the hospital to treat you once your condition has been stabilized.
- EMTALA does not obligate the hospital to treat you if the initial screening reveals your situation is not an emergency.
- EMTALA does not cover you once you have been admitted to the hospital. You can be transferred to a charity or county hospital if a new emergency arises.
- EMTALA does not require that an ambulance take you to a particular hospital.