GHC Sponsored Care Program 2 0 0 5 The Group Health Sponsored Care Program (SCP)

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Presentation transcript:

GHC Sponsored Care Program The Group Health Sponsored Care Program (SCP)

GHC Sponsored Care Program OVERVIEW The GHC Sponsored Care Program (SCP) is for GHC patients in financial need. Patients are screened for SCP based on SCP does not consider expenses or accumulated medical bills.  Enrollment status  Medically necessary hospital visits at Central or Eastside Hospital  Household income  Liquid Assets  Exceptions

GHC Sponsored Care Program SCP consists of two programs for low-income patients: OVERVIEW Charity Care Assistance is for all patients - enrolled or not - who need help with bills for care received at licensed GHC hospitals (Eastside or Central), plus related follow-up care. Patients must have income at or less than 200% of the Federal Poverty Level. Health Care Assistance is a short-term program for GHC enrollees who need help with inpatient and outpatient fees, copays, prescription costs, (and other sub programs). Patients must have income at or less than 250% of the Federal Poverty Level and meet specific enrollment criteria. Assistance includes:  6 past months of unpaid GHC bills  6 months of future GHC copays and fees.

GHC Sponsored Care Program Why does SCP exist? OVERVIEW Charity Care laws exist in Washington which require hospital systems to provide free-of-charge care to indigent (<= 200% FPL) patients, regardless if they are enrollees or not. Also, if GHC and collection agencies can’t collect owed money from GHC enrollees, unpaid bills are usually written off to bad debt. SCP is the alternative for low-income patients. Once SCP reviews and approves an application, Group Health stops billing the patient and waives normal fees by writing them off to a charity care account rather than bad debt. This supports Group Health’s non-profit status and core mission values of Respect, Integrity and Stewardship.

GHC Sponsored Care Program FLOWCHART CHARITY CARE HEALTH CARE ASSISTANCE Is patient currently enrolled in Group Health? YES DOES patient meet SCP Financial Guidelines? NO SCP assistance available. YES SCP can waive GH bills less than 6 months old, and future GH bills for outpatient services & medications for 6 months. Has patient never been enrolled, or disenrolled for more than 6 months? NO YES SCP can waive GH emergency and follow-up* bills for Central and East campus UCC, ED, outpatient and/or hospital inpatient care (if patient was admitted from ED). * Patient may schedule follow-up visits at a GHC primary care clinic. NO Has patient been continuously enrolled at least 6 months in an individual, family or GH employee plan? (New enrollees must have paid at least 6 months’ dues). Then ask SCP cannot waive GHC dues. SCP can waive dues paid directly to GHC for up to 6 months back and 6 months forward. YES NO SCP can waive fees incurred up to 6 months prior to disenrollment. NO

GHC Sponsored Care Program The SCP Website includes: RESOURCES  Referral and eligibility criteria  SCP department processes  Details on what SCP waives  FAQS & Training resources.  SCP Forms for download  In-house resources (tipsheets, other department links, etc.)  Internet resources (for seniors, community, specialty health, etc.) Make sure to visit at:  In InContext: check under ‘Departments/Patient Services’ or in ‘Departments/Alphabetic’.