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975 East Third Street
Chattanooga, TN 37403
423-778-7000
Children's Hospital at Erlanger Erlanger Baroness Campus Erlanger Bledsoe Campus Erlanger East Campus Erlanger North Campus UT Erlanger Physicians Group





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Financial/Charity Policy

Financial/Charity assistance is available to all patients who qualify after completing the application process. Financial Counselors are available to assist our patients in making applications for charity. In addition to assisting with charity, staff is available to patients in determining eligibility for programs such as TennCare or Medicaid. One of the functions of the Financial Counselors is to assist uninsured patients in determining a source of payment. For those patients not eligible for financial assistance, it is the policy of the Health System to permit patients where eligible to make regular payments on a monthly basis. Erlanger does utilize external collection firms on debt collection as needed. When appropriate, legal assistance is utilized for the purposes of collecting from those who have the ability to pay.

It is the policy of Erlanger to:

  • Treat all patients equally, with dignity, respect, and compassion.
  • Serve the emergency health needs of everyone, regardless of ability to pay.
  • Assist patients who cannot pay for part or all of the care they receive at Erlanger.
  • Balance the needed financial assistance for some patients with broader fiscal responsibilities in order to keep the Health System viable financially.
  • Respond promptly to patients questions regarding their bills and request for financial assistance.
  • Make available information regarding our charity care policy.
  • Have clear understanding of written policies to help patients determine if they are eligible for public or hospital-sponsored financial assistance programs.
  • Have written policies for discounts for patients who do not qualify under our charity policy.
  • Ensure outside collection agencies follow hospital billing and collection guidelines.

The intent of the Erlanger Health System Charity Policy is to establish a fair and equitable system for determining hospital charity. General guidelines are established, allowing for evaluation of unique financial circumstances.  

A patient is determined eligible by income standards when the annual individual or family income does not exceed 250% of the Federal Poverty Guidelines as published annually in the Federal Register. Present income will be a measured in assessing hospital charity but will not be the sole determining factor. Among other elements to be considered are temporary factors such as short term layoff, unemployment, disability or other demonstrated hardship. An evaluation of available assets will be necessary to determine eligibility for charity. If assets exist to pay the debt, charity may be denied. Medical Indigency can be a qualifying factor in determining charity care or uncompensated care.

Applications for assistance are available at Erlanger Health System between 8:00 a.m. and 4:30 p.m. (Monday through Friday). Services eligible for Charity Care are medically necessary inpatient and outpatient services.

PROGRAM GUIDELINES:

  1. Charity is evaluated on the basis of the National Poverty Guidelines. Applicants who are approved will receive a Rate which is explained on the next page.  Depending on the Rate that the patient is approved for will determine the amount the patient will be responsible for. Charity is approved for a three (3) month period. Patients must reapply for charity if there charity approval has expired.
  2. Charity applies only after all other resources have been exhausted.
  3. A determination of the applicant's eligibility is made promptly after completion of the application.
  4. Income Guidelines: To be eligible for the program, gross family income must be at or below the following levels:

    2011 HHS Poverty Guidelines  

    Persons in
    Family Unit

    48 Contiguous
    States and D.C.

    Alaska

    Hawaii

    1

    $10,890

    $13,600

    $12,540

    2

    14,710

    18,380

    16,930

    3

    18,530

    23,160

    21,320

    4

    22,350

    27,940

    25,710

    5

    26,170

    32,720

    30,100

    6

    29,990

    37,500

    34,490

    7

    33,810

    42,280

    38,880

    8

    37,630

    47,060

    43,270

    For each additional
    person, add

    3,820

    4,780

    4,390

  5. Listed below is the Rate Schedule which indicates what the patient responsibility due to Erlanger Health System for Outpatient, Same Day Surgery and Inpatient according to the rate.

    Charges for Services

    Outpatient Rates

    Same Day Surgery

    Inpatient

    Level A*

    $10.00

    $45.00

    No Charge

    Level A

    $10.00

    $45.00

    5% not to exceed $200.00

    Level B

    $15.00

    $65.00

    10% not to exceed $400.00

    Level C

    $20.00

    $90.00

    15% not to exceed $800.00

    Level D

    $25.00

    $120.00

    20% not to exceed $1200.00

    Level E

    $30.00

    $150.00

    25% not to exceed $1600.00

    Level F

    $35.00

    $180.00

    30% not to exceed $2000.00

  6. Catastrophic expenses fall under this Charity Policy. A review of the patient’s financial condition will be performed to determine eligibility under these guidelines. if the patient’s liability exceeds 50% of the prior year’s total annual family income and or assets the following guidelines will be used. 
    Income Level Payment Required
    Up to $50K  15% of annual gross income
     $50K to $75K  20% of annual gross income
     $75K to $100 K  25% of annual gross income
     Over $100K  30% of annual gross income
  7. Asset and credits investigations may be made on all charity adjustments greater than $1000.00. If it is determined that assets exist to pay the debt, charity may be disallowed.
  8. In order to be considered under the Erlanger Charity Policy the following financial information must be provided for financial status verification.

    1. The last 4 paycheck stubs.
    2. Documentation of Social Security benefits.
    3. Unemployment benefits.
    4. Retirement income.
    5. Food stamp income worksheet.
    6. Latest bank statement.
    7. Latest income tax return.

    You must provide all information listed above that pertains to you.  A hardship letter can be included to justify your inability to pay.

  9. Two separate adjustment codes will be utilized to adjust a patients account:
    Certified Hamilton County Charity Care (Adjustment code 219295)
    Out of Area Charity Care (Adjustment code 230292)
  10. Charity in cases that fall outside the established guidelines must be approved by the Director, Patient Financial Services or designee.
  11. Any applicant fraudulently misrepresenting his or her income level will be immediately disqualified for consideration for charity care. In the event the applicant makes fraudulent misrepresentations, all charges for services previously rendered will be billed to the responsible party.
  12. Any applicant for charity who does not supply the necessary documentation for the review will not be considered for charity.
  13. Any applicant who fails to tender payments under a payment plan who has received partial charity under the catastrophic guidelines will be immediately disqualified for the catastrophic charity. All charges for services previously rendered will be billed to the responsible party.
  14. When a patient applies for charity EHS will review and consider all accounts ninety (90) days or less from the date of service.

Unisured, Self-Pay patients

A Managed Care type discount of fifty three percent (53%) effective June 8, 2012 will be applied to all self-pay accounts with a date of service of June 8, 2012 and later who do not qualify for a payment source.  These discounts do not apply to programs or services which are deemed to be elective in nature.  Examples of these include wellness programs, cosmetic procedures etc.  These type programs have specific pricing and are exempt from receiving the discount.

Prompt Pay Discount for Patients with Health Insurance

Patients with health insurance (government, commercial or managed care insurance) will be eligible for a 10% prompt pay discount on balances that are the patient's responsibility.  Payment must be received and posted within fifteen days from the date of the first statement sent to the patient.  This discount does not apply to self-pay patients or charity care patients.

Monthly Payment Arrangements:

Patients are permitted to make monthly payment arrangements for amounts owed. Efforts will be made by the hospital to collect balances in full either by cash, check or credit card, prior to establishing monthly payment arrangements. In lieu of payment arrangements, hospital reserves the right to refer eligible patients for bank loans to pay off hospital account.  The hospital does not change interest on monthly payment plans, therefore long term arrangements are discouraged wherever possible. See attached schedule of payments. The minimum monthly payment is dependent on the balance of the account.
Approval by Director of PFS or designee is required if the payment is less than required by the payment schedule.

Use of outside agencies/attorneys:

When it is determined the patient has not responded to our request for payment, an account can be referred to an outside collection agency or attorney for collection assistance. 

Litigation:

When appropriate, hospital reserves the right to seek judgment for those patients who have refused to pay outstanding debt.  Hospital will not cause action to have patient removed from their property, but where appropriate will seek judgment for amount owed.
Prior to pursuing litigation, the hospital will review the detailed financial condition of patient via credit reporting to ensure litigation is appropriate.

Credit Reporting:

Erlanger routinely utilizes data provided by external agencies to verify information as to credit score, assets, etc.  This information is frequently used in assessing charity eligibility, determining medical indigency, and the viability of collection on the patients account.

Payment Schedule

$25.00 - $600.00  Minimum payment of $25.00 per month
 $601.00-$1200.00  Minimum payment of $50.00 per month
 $1201.00-$1800.00  Minimum payment of $75.00 per month
 $1801.00-$2400.00  Minimum payment of $100.00 per month
 $2401.00-$3000.00  Minimum payment of $125.00 per month
 $3001.00-$3600.00  Minimum payment of $150.00 per month
 $3601.00-$4200.00  Minimum payment of $175.00 per month
 $4201.00-$4800.00  Minimum payment of $200.00 per month
 $4801.00 & Above  Minimum payment of $225.00 per month

Approval must be obtained from the PFS Director or his designee to accept a payment plan that is less than what is described in the schedule.

Patient Financial Services Department
423-778-5150
or 800-262-5764
8:30 a.m. - 4:30 p.m.
Monday - Friday

Erlanger Health System
P.O. Box 1150
Chattanooga, TN 37401