Financial assistance is available to those who do not have adequate financial resources (including health insurance) to pay for the care that they, or someone for whom they are responsible, received. The Financial Assistance Policy (FAP) provides the opportunity for assistance through two distinct programs: The State of New Jersey’s Hospital Care Payment Assistance Program (HCPAP), and Virtua’s Charity Assistance Program (CAP). Assistance under both programs is limited to necessary hospital care. The programs do not pertain to cosmetic procedures or to professional services of other providers (such as physicians) that may be associated with the hospital care.
Based on documented assets and income, and with consideration for family size, the State’s HCPAP will provide a reduction to the gross charges associated with the care provided ranging from 20% to 100%, in 20% increments. The majority of approvals result in free care (100% adjustment). Assistance is available to those earning up to 300% of the Federal Poverty Guidelines (FPG). Completion of an application, including family/household information, proof of New Jersey residency, and documentation of income and assets, is required. Common examples of documentation needed for proof of residency are a driver’s license or a county identification card. A pay stub, W-2 Form, or a social security statement can be provided as proof of income along with a bank statement for proof of assets. If there is no income or assets an attestation provided by the patient would circumvent the need for documentation.
Those who can not qualify for assistance under the State’s program will be screened for Virtua’s program. Virtua’s CAP is available to all citizens of the United States. The eligibility criterion is also less restrictive as there is no asset test and those earning up to 500% of the FPG are eligible for assistance. Qualification under Virtua’s CAP will result in an 88% reduction to the gross charges associated with the care provided. This reduction results in an amount less than what is generally billed to individuals who have insurance coverage, based on a review of the relationship between gross charges and payments for care provided to insured individuals. Following the reduction, the expected amount due is also less than 115% of Medicare reimbursement. Completion of an application, including family/household information, proof of United States citizenship, and documentation of income, is required. The aforementioned common documentation examples noted above apply as applicable.
The accounts of patients for which there is no identified third party health insurance coverage will follow the defined self pay collection cycle, with the responsible party being made aware of the availability of the HCPAP and the CAP. Any remaining unpaid accounts that are not in the process of making payment arrangements or being approved for the HCPAP or CAP at the end of the defined self pay collection cycle (120 days) will be transferred to a third party agency for collection. Prior to this transfer, however, an estimation of the responsible party’s annual income will be obtained from an outside credit agency. If it can be determined based on the income estimation that the individual would meet the CAP criteria, the aforementioned reduction to charges will be applied with the net remaining balance transferred to a third party agency for collection. The account will remain with the agency for 180 days. After this time period, absence the existence of an agreed upon arrangement to resolve the outstanding balance, the account will be transferred to another third party collection agency. At this time the unpaid obligation may be reported to a credit agency and thus appear on the account guarantor’s credit report. At any point in the above collection cycle the account may be referred to a collection attorney based on lack of cooperation of the debtor and evidence of the debtor’s ability to pay. Legal action may be pursued to secure satisfaction of the financial obligation.
Virtua’s Patient Accounting Department will use its best efforts to provide financial assistance fairly and consistently, using reasonable efforts to determine whether an individual is eligible for financial assistance. As Virtua must balance our patients' needs for financial assistance with our own broader fiscal responsibility, assistance is not considered to be a substitute for personal responsibility. Individuals deemed to have the financial means to pay for their care shall be expected to do so, and Virtua reserves the right to take action as permissible under the law to protect its assets as necessary.
Virtua’s FAP and associated forms are available in English and in Spanish. The FAP is on display in emergency room, outpatient, and admission registration locations. Registrars have the policy and forms readily available to print out upon patient request. Information, applications, and the FAP is posted on Virtua’s website, www.virtua.org, to notify the community of the FAP’s existence and ready availability. The application is printable to make it easy for a patient to complete at home.