Family Health Care of Siouxland offers a financial assistance program to patients experiencing financial difficulty, should they qualify. The bottom portion of page one needs to be completed by Family Health Care of Siouxland prior to sending the application to the patient. If clinic staff is completing this section a copy of page one needs to go to Central Billing Collections staff, so the date sent to patient is logged into the practice management system and the application tracked.
The patient has twenty (20) days from the date the letter is sent to return the completed application, along with:
- Copy of Tax Return from previous year
- Payroll stubs for all adults in household (age 18 & older) for past 2 months
Family Health Care follows the US Department of Health & Human Services Poverty Guidelines. These guidelines are based on the number of people in the family that are claimed on income tax. The patient could qualify for 0%-100% assistance, which is good for 3 months, after which time they will need to reapply. The discount only applies to services that are medically necessary.
- Tier 1: If the patient is at 151% -200% poverty rate, they qualify for a 25% discount.
- Tier 2: If the patient is at 126% – 150% poverty rate, they qualify for 50% discount.
- Tier 3: If the patient is at 101% – 125% poverty rate, they qualify for 75% discount
- Tier 4: If the patient is at 100% or below poverty rate, they qualify for 100% discount.
If the patient doesn’t return all of the supporting documentation with the application, it is filed and a note put in the computer. A letter is sent to the patient giving them seven (7) days to return the required documentation.
After the application is returned and processed, if they are eligible for a discount the information is sent to the clinic manager for approval or denial. A letter is then sent to the patient notifying them if they qualified, and if so what amount of financial assistance they qualified for. If they do not qualify a letter is sent to them offering our payment plan.
Patients can only qualify 3 times for financial assistance, for a total of 9 months.