PURPOSE

Orlando Orthopaedic Outpatient Surgery Center, LLC is committed to providing Health Care Services to patients in Orange County and surrounding service areas regardless of their ability to pay. The Charity Care Policy was established to provide financial relief to those who are unable to meet their financial obligation to Orlando Orthopaedic Outpatient Surgery Center.

Charity Care applies to charges for traditional, non-elective healthcare services to patients meeting the financial criteria set by the Surgery Center using the Federal Poverty Income Guidelines found at https://aspe.hhs.gov/poverty-guidelines

CHARITY CARE CRITERIA

All outpatient accounts are eligible for uncompensated care consideration. A Charity Care Application must be filled out by the patient/guarantor. Eligibility is based on income, family size and cash assets.

A. Patients with current Medicaid benefits having a procedure not covered by Medicaid, and not cosmetic in nature, will be approved for charity care based on their qualification under the Medicaid program. Proof of current Medicaid eligibility will be verified prior to approval.
B. Patients at 150% or less of the current Federal Poverty Income level, from all sources, will qualify for Charity Care with completed application.
C. Patients at 151% or higher will be considered for Charity Care on a case by case basis with completed application.

CHARITY CARE APPLICATION DOCUMENTATION

Orlando Orthopaedic Outpatient Surgery Center, LLC may require some or all of the following documentation based upon the individual Charity Care Application

Required Documentation

A. Proof of Income – from all sources, listing gross income for the most recent four-week period.

B. Copies of most recent Federal Income Tax Return.

C. Last two months on bank statements for savings accounts and checking accounts.

D. Cash balances as of the date of service from certificates of deposit, stocks and bonds.

E. Number of dependents. Unborn children are not added to the family size. Death of a spouse or dependents will only be included in family size for the year of the death.

Other Documentation at the Request of Orlando Orthopaedic Outpatient Surgery Center, LLC

F. Assets including home, automobiles, boats and real estate other than primary residences.

G. Monthly household expenses as well as loan payments.

H. Credit Bureau check on accounts balances of $2,000 or more.

I. Board of Assessment – Property Value check (as required).

CHARITY CARE APPLICATION POLICY

A. Applicants for charity care will complete a charity care application. Orlando Orthopaedic Outpatient Surgery Center reserves the right to check the veracity of the information at their discretion.

B. Orlando Orthopaedic Outpatient Surgery Center prefers that the application be completed prior to or immediately following the date of service but will accept applications within 90 days from the date of service. The surgery center reserves the right to grant extension to the time frame cited and to deny an application if received after an extended period of time.

C. Loss of employment will be considered temporary until nine months have elapsed and will not be considered in the income evaluation.

D. Cash balances above the criteria will be applied to the outstanding balances first then the applicable reduction will be applied to the balance.

E. Incomplete applications will be returned unprocessed. Applications sent to the guarantor/patient at their request must be returned within 30 days to be considered.

F. The surgery center reserves the right to review benefit determination if financial circumstances have changed substantially.

CHARITY CARE APPLICATION PROCEDURE

A. Completed application (and supporting documents) is reviewed and a determination of eligibility is made within 30 days. Written notice of determination is forwarded to the guarantor/patient. Copies of all documents are kept in the patients chart.

B. Charity Care charges are entered into the patient accounting system and then written- off at the same time. The comment section of the patient accounting system should document this occurrence and the reasons for the anticipated charity handling.

C. If patient is Medicaid eligible, application to Medicaid must be completed and eligibility determined before consideration for assistance.

D. Current account balances will be the basis for consideration for assistance; previous balances that have resulted in bad debt classification will not be considered.

E. Each application is effective for accounts listed as well as future service that occurs within 180 days of the last approved application. A complete application would have to be completed for services that occur after the 180-day limit.

F. Applications are considered confidential in nature, the property of Orlando Orthopaedic Outpatient Surgery Center, and will be retained for a period of seven years.