Charity Care Policy

It is the policy of Waterbury Hospital to appropriately offer charity care in situations where the responsible party for the balance due does not have the financial resources necessary to satisfy their obligation within a reasonable period of time.

1. All patients who request consideration for charity care will be required to apply for public assistance in addition to completing a charity care application unless identified as ineligible by a qualified case worker.
2. In order to be considered for charity care, full financial disclosure is required including:
   1. All sources of income available at the time of application;
   2. Assets excluding;
      1. Primary Residence;
      2. Vehicles required for commuting to or facilitating employment;
      3. Retirement Accounts.
3. Responsible parties with assets of $7,500 or less ($15,000 for a couple) will receive the following discounts based on their annual household income and the published federal poverty guidelines in effect at the date of application: 

   Income as a % of FPL	Discount
   <200%	100%
   <225%	60%
   <275%	40%
   <300%	20%
   <400%	10%

4. Charity care discounts are to be applied after the 50% uninsured discount from charges.
5. Documentation required to validate declarations made on the charity care application shall include:
   1. A credit report;
   2. Most recent 1040 tax return;
   3. Copies of all bank statements to include but not limited to:
      1. Checking accounts;
      2. Savings accounts;
      3. Investment accounts;
      4. Certificates of deposit
   4. Proof of income for the immediate 12 months preceding the application date.
   5. Public assistance determination.

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Contains Proprietary Information and is for the use of Waterbury Hospital only.

Charity Care Procedure

1. The availability of charity care will be disclosed on all dunning notices issued prior to bad debt assignment.
2. Patients who indicate they are unable to pay for services rendered will be offered charity care.
3. Financial Counselors shall evaluate each applicant’s eligibility.
4. Accounts determined to be eligible for charity care discounts shall require the following authorization based on amount to be adjusted:
   1. PAFS Manager < $5,000
   2. PAFS Director $5,000 or more
   3. Chief Financial Officer $10,000 or more
5. Patients shall be issued a determination letter within 30 days of receipt of a completed charity care application.
6. Patients who do not apply for or do not qualify for charity care will be expected to pay the balance due. For uninsured patients, this will be equivalent to 50% of charges. Insured patients will be expected to pay any deductible or co-payment due in addition to 50% of non-covered charges.
7. Patient who do not enter into a payment plan or pay satisfy the balance due will be placed with a collection agency for further collection efforts. The collection agency may report the balance due to credit reporting bureaus and/or initiate legal action to resolve the debt.