Financial Assistance


To download the financial assistance policy and application in Spanish, click here.
Para descargar la política de asistencia financiera y la aplicación en español, haga clic aquí.





Southwest Health System Inc. (SHS) is dedicated to providing medically necessary healthcare services. These services are accessible to all without regard to age, race, color, disability, sex, sexual orientation, national origin, religion, marital status, political affiliation, veteran status, ability to pay, or genetic information. To assist in meeting those needs, we have established a policy to provide financial relief to those patients in need of medically necessary services and who are unable to meet their financial obligation due to being low-income uninsured, underinsured or medically indigent.

The Financial Assistance Program will be updated annually in accordance with the Federal Poverty Guidelines as established by the Department of Health and Human Services. Under the rules and regulations, SHS is permitted to charge interest to any outstanding balance owed, however, it has been decided not to charge interest at this time.


The basis of these programs is the truthful and accurate provision and submission of financial information from the patient and/or responsible party(s). Patients and/or responsible party(s) that intentionally misrepresent their household financial information will be automatically disqualified from any consideration whatsoever with regard to this program.  Intentional misrepresentation determination is the sole right of SHS.


Financial Assistance is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with SHS’ procedures for obtaining other forms of payment or financial assistance, and to contribute to the cost of their care based on their individual ability to pay.


SCOPE
Southwest Health System, Inc. its patients and/or their responsible party(ies).

DEFINITIONS

Allowable Expenses: SHS may take into consideration actual payments made for day care, elderly care, child support payments, alimony payments, and health insurance premiums. Medical expenses due may also be taken into consideration.


Application Period: Timeframe in which SHS may accept Financial Assistance Program applications submitted by an individual. The period ends on the 240th day after SHS provides the individual with the first billing statement.


Covered Services: Medically necessary services provided by an entity of Southwest Health System, Inc.


Discounted Charges: Amount owed by the patient and/or responsible party(ies) for patient accounts that have been reduced due to eligibility for the Financial Assistance Program. Individuals eligible for the Financial Assistance Program may not be charged more than what Medicare pays, which are lower than any private health plan payment made to SHS.


Extraordinary Collection Actions (ECA): Include actions that require legal or judicial process taken by SHS against an individual related to obtaining payment of a bill for care covered under the Financial Assistance Program.


Family: Patient, his/her spouse (including a legal common law spouse) and his/her legal dependents according to the Internal Revenue Service rules.


Household: Family and their income and expenses.


Income: Gross wages, salaries, Social Security benefits, unemployment compensation, workers compensation, regular support from family members not living in the household, government pensions, private pensions, regular gifts and other monies regularly received.


Low-Income: Annual family income not more than 250% of the Federal Poverty Level Guidelines as published by the Department of Health and Human Services.


Medically Indigent: Patient and/or responsible party(ies) having Insufficient income in relation to medical expenses to be able to pay for medically necessary services.


Medically Necessary Service: Medical services considered to be necessary as defined by the Department of Health Care Policy and Financing 10 CCR 2505-10 Section 8.076.1.8. Cosmetic services are excluded.


Notification Period: Timeframe in which SHS notifies an individual of the Financial Assistance Program. This period begins on the date that care is provided to the individual and ends on the 120th day after SHS provides the individual with the first billing statement for care rendered. If an individual fails to submit an application by the end of the notification period and SHS has met notification requirements, SHS may engage in Extraordinary Collection Actions.


Patient Account: Encounter where medical services are rendered to an individual.


Responsible Party(ies): Person or persons legally responsible to pay for charges or services ordered on behalf of a patient.


Underinsured: Patient insurance that is financially inadequate.


Uninsured: Patient not covered by insurance.


POLICY


Southwest Health System, Inc. is dedicated to providing medically necessary healthcare services. These services are accessible to all without regard to age, race, color, disability, sex, sexual orientation, national origin, religion, marital status, political affiliation, veteran status, ability to pay, or genetic information.


To assist in meeting medically necessary healthcare needs, SHS may provide financial relief to those who are unable to meet their financial obligation due to being low-income uninsured, underinsured and/or medically indigent.


Information regarding SHS’s Financial Assistance Program is available on the SHS website and in SHS public areas. It is made available upon request, during registration, and within billing statements for the notification period. Information is conveyed in a clear and understandable manner at no charge.


The Financial Assistance Program is not considered to be a substitute for personal responsibility. The responsible party(ies) is expected to cooperate with SHS for obtaining other forms of payment or financial resources and to contribute to the cost of their care based on their ability to pay.


The basis of the Financial Assistance Program is the truthful and accurate provision and submission of financial information from the patient and/or responsible party (ies). Patient and/or responsible party (ies) who intentionally misrepresent their household information will be automatically disqualified from any consideration whatsoever with regard to the program. Intentional misrepresentation determination is the sole right of SHS.


This policy and its associated materials are updated annually in accordance with the Federal Poverty Guidelines as established by the Department of Health and Human Services.


PROCEDURE


A person may request information or an application for the Financial Assistance Program by mail, telephone or in person by contacting:


Southwest Health System, Inc.
Attention: Patient Financial Counseling
1311 N Mildred Road
Cortez, CO 81321
Phone: (970) 564-2130
Email: insurancequestions@swhealth.org


Individuals should have a patient account that falls within the application period prior to applying for the Financial Assistance Program. SHS will make efforts to assist individuals in finding funding resources (i.e. Medicaid, Commercial Insurance, Colorado Indigent Care Program, etc.) prior to processing applications. Proof of denial for funding resources may be requested prior to FAP approval.


Eligibility Requirements: Eligibility for FAP is determined based upon demographic and financial information. Medically indigent cases are considered on a case by case basis. To be eligible patients and/or patient accounts must be:


  • Uninsured or underinsured
  • For medically necessary services
  • Resident of Colorado at the time of services
  • Provide proof of lawful presence
  • Gross income (before taxes) minus allowable expenses equal no more than 250% of the Federal Poverty Level.
  • Other funding resources, federal resources and state resources have been exhausted.

 

Considerations outside of the eligibility requirements must be approved by SHS Administration.


Application Requirements: Application completion should be within the Application Period. SHS will make reasonable attempts to inform an individual when an incomplete application is submitted. Incomplete applications may include:


  • FAP application not filled out in its entirety or accurately
  • Supporting documentation not received by SHS.

Completed applications are submitted for approval or denial. Applicants will be notified of application approval or denial status.


Approved FAP applications may be effective up to a year with consideration to income and expense variations. Individuals can complete a new application when more than one year has elapsed from prior applications.


Patient account adjustments under the FAP may be provided for covered services when eligibility requirements and application requirements have been met. Patient account adjustments are processed for approval or denial on a case by case basis. Applicants will be notified of discounted charges and non-discounted charges on a case by case basis.





Download the full policy here.