I BEGIN THIS column with no small degree of trepidation because it’s going to be about charity care — specifically charity care as it relates to hospital bills.
On one hand, I know that some folks struggle with hospital bills — struggle, as in they feel hopeless.
On the other hand, I know how hard it is for some of our local, rural hospitals to keep their doors open in the face of ridiculously low Medicaid and Medicare payments, etc., and I do not want to see them go under financially.
Still, this is public information, and people have a right to know, so here we go.
Charity care (aka financial assistance) is required of all hospitals by state law.
If you need hospital care, have a bill from a hospital or the bill has been sent to collections, charity care might apply.
Basically, charity care can cover “medically necessary services” (not just emergencies) in the form of deposits, co-payments, deductibles or anything that any applicable insurance doesn’t cover.
So it isn’t only for uninsured folks; it also can apply to underinsured folks (meaning what’s left after your insurance has paid whatever it’s going to pay).
You qualify for this if your family income is at or below 100 percent of the federal poverty level, e.g., for a household of two, that’s $16,240 per year in 2017; for a household of four, it’s $24,600 per year, etc.
All hospitals have the full chart available.
If your household income is between 100 percent and 200 percent of federal poverty (household of two equals $32,480, household of four equals $49,200), you’d be eligible for a discount.
It’s also entirely possible that a particular hospital might offer free care or discounts to those of us with higher incomes, so don’t hesitate to ask.
What is household income?
Smart question: It’s the combined income of everyone in your household who is related by birth, marriage or adoption, and would include wages (before taxes), Social Security, welfare payments/child supports, etc. Pretty much everything.
And what about assets?
If you’re at or below 100 percent, assets are irrelevant, but they might be figured in if you’re between 100 percent and 200 percent.
What do you actually do?
Ask the hospital for charity care as soon as you know that you’ve got a problem and think you might qualify, and you’ll be given an application.
Fill the application out ASAP and get it turned in.
You’ll need to verify income with pay stubs, last year’s income tax return or W-2, a written statement from employer(s) or whatever you can get your hands on.
If all else fails, the hospital has to accept a signed statement from you as to your household income.
Make copies of everything (including the application) before you turn them in.
The hospital has to decide about your eligibility within 14 days.
If you’re denied, they must tell you why or ask for additional information and inform you of your 30-day appeal rights.
If you need help or the whole thing just goes sideways and you are low-income, you can call Coordinated Legal Education, Advice and Referral (CLEAR) at 888-201-1014 Mondays through Fridays, 9:15 a.m. to 12:15 p.m.
If you’re 60 or older, you could call CLEAR*Sr at 888-387-7111, regardless of your income.
That’s how it works. Now, let’s think for a minute:
Is this the answer for everyone who has an unaffordable hospital bill, even after whatever insurance you have has paid whatever it’s going to pay?
No, although it never hurts to ask or to try.
Many of us can still struggle with hospital bills, even if our household incomes are substantially above those federal poverty levels I gave you, because we have annoying little things such as rent/mortgage payments, utilities, other medical expenses, food, etc., ad infinitum.
Again, it never hurts to make some inquiries, and remember that many hospitals will be more than willing to negotiate a payment schedule if we initiate an honest conversation and proceed honorably.
Here’s the other side of the coin: pride.
We know darned good and well that there’s no way we can afford the bill, and our income is below the mandatory standards, but we don’t say or do anything because we’re ashamed to admit it, don’t want to take welfare or don’t want other people (especially in small communities) to know our business, so we do nothing.
Then, we struggle.
And maybe we do without prescriptions, enough food, enough heat or whatever else, and our whole situation spirals downward until the inevitable crisis occurs.
That doesn’t usually get us anywhere we really wanted to be, and we all know what pride cometh before.
However, we all make our own decisions.
So be it. Personally, I’d rather see folks take help that’s available (if they really need to) so they can keep themselves and the people they love as healthy and functional as possible, but that’s not my decision to make.
My job is to give you the information. Your job is to run your life.
So be it.
Mark Harvey is director of Clallam/Jefferson Senior Information & Assistance, which operates through the Olympic Area Agency on Aging. He is also a member of the Community Advocates for Rural Elders partnership. He can be reached at 360-452-3221 (Port Angeles-Sequim), 360-385-2552 (Jefferson County) or 360-374-9496 (West End), or by emailing [email protected].