Financial Assistance/Charity Care Policy
Mount Sinai Hospital recognizes that many of the patients it serves may be unable to access quality health care services without financial assistance. Our Financial Assistance/Charity Care Policy was developed to ensure that The Hospital continues to uphold its mission of providing quality health care to the community, while carefully taking into consideration the ability of the patient to pay, as applied in a fair and consistent manner.
Administration of this policy is executed through the Department of Patient Financial Services ("PFS").
All patients of The Hospital will have access to information regarding estimated or actual charges for hospital services and will be assisted in applying for public insurance or government or hospital charity care programs based on financial need.
- Patients are considered eligible to qualify under the Policy if they:
- Meet all financial, residency (as applicable) requirements
- Are uninsured, have exhausted, or will exhaust all available insurance benefits.
- Patients are considered ineligible to qualify under the Policy if any of the following apply:
- False information was provided by the patient or responsible party
- The patient or responsible party refuses to cooperate with any of the terms of this policy
- The patient or responsible party refuses to apply for government insurance programs after it is determined that the patient or responsible party is likely to be eligible for those programs.
- Patients may appeal a determination of ineligibility
Eligible & Non-eligible Services
Eligible services include all hospital charges that are medically necessary, such as:
- Inpatient services
- Ambulatory surgery
- Emergency care
- Outpatient services including clinic
Non-eligible services include:
- Services provided that are not medically necessary e.g. cosmetic surgery
- Physician fees are not covered by this policy
- Discretionary charges, e.g. requested private room, private nurse, phone, TV, etc.
In cases of dispute of medical necessity, the Utilization Review department or The Hospital’s Chief Medical Officer will make the final determination of medical necessity.
PFS or their designee will determine if a patient has third party coverage. If no third party coverage exists, PFS or their designee will determine if the patient is eligible for government insurance programs.
If the patient is ineligible for government insurance programs and if PFS or their designee agrees with such determination, the Policy and associated payment options should be explained to the patient and an application should be completed by the patient or responsible party.
Patients must provide the following documentation with the Policy application (documentation must meet the standards of proof applied by Medicaid to Medicaid application documentation):
- Proof of address
- Income verification (wages, disability benefits, comp, etc) by providing:
- 30 days of recent payroll stubs; AND/OR
- Letter from the Social Security Administration or the New York State Department of Labor regarding unemployment benefits; AND/OR
- Letter of support from individuals providing for patient’s basic living needs;
- Proof of dependents
- Proof of child support, alimony
Charity Care eligibility is determined based on family size and income level:
- For services covered by this Policy, PFS or their designee will apply the sliding fee scale based on gross income as defined and set forth in this Policy.
- The Sliding Fee Scale Table will be adjusted periodically to remain consistent with Federal Poverty Level updates and may be further revised at Mount Sinai’s discretion.
The Financial Assistance Representative’s immediate supervisor will review each application and make a final determination on Charity Care eligibility and payment agreements. PFS or their designee staff shall make reasonable efforts to determine eligibility for Charity Care within 10 business days of receipt of a completed application (including all required supporting documentation).
Patients who receive additional services beyond the originally agreed upon services shall remain financially liable for the additional services, and such, modification may result in a re-evaluation of the patient’s eligibility under this policy or any other programs available.
Mount Sinai Hospital reserves the right to evaluate any patient’s eligibility on a case-by case basis, especially where complex medical, scientific or financial situations exist.
When PFS or their designee finds a patient eligible for Charity Care, an appropriate discount is determined based on the Sliding Fee Scale Discount Table. The patient or responsible party will be notified in writing of eligibility and, if eligible, asked to sign a payment agreement. The New York State surcharge will be included in all amounts determined to be the patient’s responsibility, as appropriate under the Health Care Reform Act.
Appeal of Eligibility Determination
A patient has the right to appeal decisions on eligibility for Charity Care within 30 days of notification of non-eligibility. Appeals can only be submitted based on the following:
- Incorrect information was provided; OR
- A change in the patient’s financial status occurred; OR
- Due to extenuating circumstances
Appeals will be considered in cases where incorrect information was provided, where changes occur in a patient’s financial status or in cases involving extenuating circumstances. They should be made in writing to the Director of Patient Financial Services at the following address:
Mount Sinai Hospital
Patient Financial Services
One Gustave L. Levy Place
New York City N.Y. 10029
Attn: Erwin Ramirez, Senior Director Patient Financial Services
Patient Financial Services will make reasonable efforts to issue an appeals decision within 10 business days of receipt of a patient appeal (i.e., after receipt of letter, email or fax). At their discretion, PFS may request that an application or additional appeal be filed for Government sponsored benefits as part of the Charity Care appeal process.
Follow-Up Payment Information
Please bear in mind the following, regarding follow-up payments and paperwork:
- Patients are responsible for promptly reporting changes in financial status and/or contact information to the PFS or their designee.
- If a patient or responsible party is unable to comply with a signed payment agreement they must contact PFS or their designee.
- If a patient or responsible party defaults on a financial agreement with The Hospital, the account in question will be considered delinquent and may be referred to a collection agency.
- The Hospital reserves the right to refer patient accounts to an outside collection service, where appropriate, consistent with guidelines set forth in The Mount Sinai Hospital Collections Policy and by law.
Patients obtain information on hospital charges and eligibility for government or hospital programs (including the Policy) primarily from:
- Patient Financial Services
- The Outpatient Registration Department
- REAP Program
- Multilingual signage or brochures at points of patient service
- Information distributed in the admission package
- Responses to direct inquiries made to Mount Sinai Hospital;
- Bills sent to all Self-Pay patients for full charges which will include information on who to contact if the patient believes they will have difficulty in paying the balance due.
All patients will be provided charge information for specific procedures as requested.
For elective services, PFS or their designee will supply standard hospital charge (full charge rates) information to patients in addition to information regarding this Policy. For services rendered to diagnose or treat an emergency medical condition:
- Appropriate medical screening and stabilization services will be completed before a Financial Counselor seeks information concerning sources of payment.
- Neither the registrar nor PFS or their designee staff shall take any action that might inhibit The Hospital’s compliance with its obligations under the Emergency Medical Treatment and Labor Act ("EMTALA") and hospital policies on compliance with EMTALA.
- Emergency Department services will be billed at full charges with information about whom to contact if the patient believes they will have difficulty in paying the balance due.
Collection agencies must follow the same guiding principles as outlined in the Policy and as are prudent, based on a patient’s or responsible party’s financial history and current financial situation. Certain legal actions (e.g. liens or garnishments) will only be approved in cases where the Patient Financial Services determines that a patient has the means to pay outstanding balances. The collection agency must present documentation to the Patient Financial Services supporting such action.