Providing assistance for payment of care
Shawnee Mission Health (SMH) improves health through Christian service to all regardless of their ability to pay. Patients unable to pay for services should consult SMH financial counselors for assistance with identifying available resources to meet financial obligations.
The SMH financial assistance policy provides guidelines for financial assistance based on financial need to self-pay patients receiving emergency and other non-elective services for medical conditions that would cause patients harm without immediate attention. These services apply to Emergency Department outpatients, Emergency Department admissions and follow-up care relating to previous emergency visits. Assistance may range from full write-off to discounted care and is in addition to other discounts offered by SMH.
All or a portion of emergency and non-elective services may be considered for financial assistance if certain conditions exist.
SMH's financial assistance policies are transparent and available to all in compliance with the Language Assistance Services Act. Hospital signage, charity care policies, financial assistance forms and contact information are available in English and Spanish.
SMH provides financial counselors to those who are considered “self-pay.” Billing statements also include instructions on how to obtain financial assistance.
Both SMH and the patient are accountable for their role in the financial assistance process. SMH is responsible for evaluating patient eligibility for financial assistance based on the charity care policy as well as notifying the patient on payment options while honoring the patient’s right to appeal decisions. Correspondingly, patients are responsible for providing accurate information and all documentation necessary to apply for financial assistance. Please click here to read about patient responsibilities in full.
How requests are handled
When determining patient eligibility for financial assistance, SMH promises to be equitable, consistent and timely. Requests for financial assistance will be accepted up to six (6) months from the date the first statement is remitted to the patient.
Requests may be received from multiple sources. Requests received from a third party will be directed to a financial counselor who will secure proper clearance from the patient and then work with the third party on the patient’s behalf.
SMH financial counselors attempt to contact all registered, self-pay inpatients during their hospital stay in order to assess needs. In addition, SMH may utilize internal staff or third party agents to assist patients in securing Medicaid coverage if eligible. Patient collections communications also inform patients of the availability of financial assistance. Liens attached to insurance (auto, liability, life and health) are permitted. No other personal judgments or liens will be filed against non-elective self-pay patients by a hospital for those with an annual family income of less than 400 percent of Federal Poverty Guidelines.
All patients requesting financial assistance will be required to complete SMH’s Financial Assistance Application Form in order to establish eligibility. Patients may be eligible for charity care if they are uninsured and represented by specific circumstances. Please click here to read a full list of these circumstances.
The completed Financial Assistance Application Form will be submitted to SMH’s Patient Financial Services (PFS) department for processing. PFS requires proof of income including employer pay stubs, employer attestation and/or IRS tax return summary. In addition, Medicare beneficiaries are subject to an additional asset test in accordance with Federal Law. This review is completed to determine patient eligibility based on the patient’s total resources (including but not limited to family income level, assets [as required for Medicare patients] and other pertinent information).
Financial assistance approvals will be made according to SMH Charity Care Guidelines. To be eligible for a 100 percent reduction from charges, patients must have a household income at or below 200 percent of the current Federal Poverty Guidelines. Patients with a household income exceeding 200 percent but less than 400 percent will be eligible for a sliding scale discount. The minimum discount for self-pay payments of non-elective services will be 30 percent with an additional discount opportunity for prompt payment. An asset test is mandatory for Medicare patients. The Medicare patient is responsible for the greater of: 1) Seven percent (7%) of Available Assets (defined as cash, cash equivalent and non-retirement investments) or 2) Required payment per the Charity and Self-pay Discount Worksheet for Non-Elective Services.
When determining the patient’s income, the household size and income includes all immediate family members and other dependents in the household. This includes an adult (and spouse if applicable), natural or adopted minor children of adult or spouse, students over 18 years of age dependent on the family for over 50 percent support, and any other persons dependent on the family income for over 50 percent support (a current tax return of the responsible adult is required). Income may be verified by submitting a personal financial statement, copies of W-2, 1040 forms, bank statements or any other form of documentation that supports reported income.
Financial applications processed by PFS are reviewed by SMH’s Charity Care Committee monthly. The patient will be notified of eligibility for charity care generally within 60 days of receiving a completed application and all required supporting documentation. If the patient disagrees with the decision, he or she may request an appeal in writing within 45 days of the denial and include any additional relevant information that may assist in the appeal evaluation. For those patients who have applied for Medicaid, collection activity will be suspended during the consideration of a completed application. This practice is a courtesy and does not alleviate the financial obligation.
Payment plans for partial charity accounts will be individually developed with the patient. All collection activities will be conducted in conformance with the federal and state laws governing debt collection practices. If the patient does not make three consecutive monthly payments, SMH may refer the patient to collections. Careful records are kept of all charity care transactions.
The provision of charity care may now or in the future be subject to federal, state or local law. Such law governs to the extent it imposes more stringent requirements than this policy.
For further information, call 913-676-7558.
- No third-party coverage is available.
- Third-party coverage is available but with limited benefits.
- Third-party coverage is denied due to pre-existing conditions.
- Patient is already eligible for assistance (e.g. Medicaid), but the particular services are not covered.
- Medicare or Medicaid benefits have been exhausted and the patient has no further ability to pay.
- Welfare assistance is denied due to resources and/or income, but the patient is deemed by SMH to be in circumstances in which an illness will make it impossible to meet financial obligations.
- Patient meets local and state charity requirements.
- To be considered for a discount under the charity care policy, the patient must cooperate with SMH to provide the information and documentation necessary to apply for other existing financial resources that may be available to pay for health care, such as Medicare, Medicaid, third-party liability, etc.
- To be considered for a discount under the charity care policy, the patient must provide SMH with financial and other information needed to determine eligibility. This includes completing the required application forms and cooperating fully with the information gathering and assessment process.
- A patient who qualifies for a partial discount must cooperate with the hospital in establishing a reasonable payment plan.
- A patient who qualifies for a partial discount must make good-faith efforts to honor the payment plans for the discounted hospital bills. The patient is responsible to promptly notify SMH of any change in financial status so that the impact of this change may be evaluated against financial assistance policies governing the provision of charity care, the discounted hospital bills or provisions of payment plans.
- Patient is homeless.
- Patient is deceased and has no known estate able to pay hospital debts.
- Patient is incarcerated for a felony.
- Patient is currently eligible for Medicaid but was not at the date of the health care service.
- Patient is eligible by the State to receive assistance under the Violent Crime Victims Compensation Act or Sexual Assault Victims Compensation Act.
- Patient is eligible for the Centers for Medicare and Medicaid funding for certain emergency health services provided to undocumented aliens in accordance with the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), Section 1011, regardless of whether Section 1011 funds for the applicable state are exhausted.
- Patient is deemed to have minimal financial resources based on a proprietary third party tool utilized by the facility.