Sliding Fee Scale Guidelines
Wellspring Family Medicine, PC shall adopt the sliding fee scale prepared by the United States Department of Health and Human Services and published in the Federal Register, that considers a person’s ability to pay for services and that ensures that no person is denied services for inability to pay, while also ensuring that those persons who can pay for services pay an amount commensurate with their ability to pay.
Wellspring Family Medicine, PC shall collect fees for its services; provided, however, if it is determined that a person receiving services is unable to pay the total fee, Facility shall collect any amount such person is able to pay.
Wellspring Family Medicine, PC as appropriate, shall investigate or cause to be investigated the financial ability of each patient and all other persons legally liable for the cost or care of the patient, and the sliding fee scale shall be employed in accordance with the ability of the person(s) assessed to pay.
The sliding fee scale used shall be changed each year to update the income figures to be in compliance with the most recent poverty guidelines published by the United States Department of Health and Human Services.
The annual poverty guidelines published by the United States Department of Health and Human Services shall be used to determine a discount to be applied to the regular private pay charge. In determining the discounted rate, Facility may require submission of proof of income amounts claimed.
In the event that a person or family is still unable to pay the discounted rate, Wellspring Family Medicine, PC may further adjust the required payment to a level that can be paid. No person may be denied service based on the inability to pay. In determining additional discounts, Wellspring Family Medicine, PC may require additional documentation concerning assets and income as may be deemed necessary to determine the person’s or family’s true ability to pay.
Even where a discounted rate is determined, the full amount of the private pay rate will continue to be billed. The billing shall indicate both the total amount of the bill, and the amount that is actually due at the present time. The purpose for this is so that, in the event of an estate settlement, the facility may assess the estate for the full amount charged and not just the discounted rate. The billing shall also state that the full charge, less any payments that have been received, will be assessed against any estate assets.
The discounted rate shall apply only to private pay amounts. Amounts due from third party insurers, including Medicare and Medicaid, shall not be discounted using this policy but may be discounted below the full private pay rate in the case of Medicare and Medicaid under participation agreement with those entities. Third party insurers other than Medicare and Medicaid may pay less than the full charge under the provisions of the policy issued; in cases where this occurs, the discount rate may still be applied to the amount remaining due from the patient.
In cases where a third party payment is deemed to be payment in full for covered services, no additional amount may be assessed for the services deemed to be covered even if the payment received is less that the full private pay rate.
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