Carle hospital expands charity program

Carle hospital expands charity program

URBANA – More patients will qualify for free or discounted care at Carle Foundation Hospital, starting today.

Under an expansion of the hospital's Community Care Discount Program, people earning as much as 400 percent of the federal poverty level are now eligible for a cap on their out-of-pocket hospital expenses.

Those earning as much as 300 percent of the federal poverty level and less are eligible for free or discounted care.

What's more, hospital officials said, they will no longer count funds in official retirement accounts when they're looking at patients' financial ability to pay their bills.

The hospital last expanded its Community Care program in February 2004, but there were still too many needy patients falling through the cracks, one hospital official said.

The expansion last year "helped a significant number of people," said Robert Tonkinson, Carle hospital's chief financial officer. "But we were still seeing that there are people we feel we could help, who are struggling to pay their bills."

Under the old Community Care guidelines, Carle hospital provided free health care to people earning up to 150 percent of the federal poverty level. Sliding scale discounts were given to people earning up to 250 percent of the federal poverty level.

Under the new guidelines, the hospital will provide:

– Free care to people earning up to 200 percent of the federal poverty level.

– A sliding scale discount to those earning up to 300 percent of the federal poverty level.

– A cap on out-of-pocket medical expenses for patients earning at or below 400 percent of the federal poverty level. The cap limits out-of-pocket expenses to 40 percent of the patient's gross annual income.

– A 25 percent discount for any uninsured patient, regardless of the patient's income level, if the bill is paid in 30 days.

Under the new guidelines, the hospital is also promising to undertake a credit analysis before initiating a collection process on an outstanding account, and to notify all patients of what the Community Care program offers at the time they register.

Under the former guidelines, a family of four would have had to earn less than $27,600 to qualify for free care. Now the same family can earn up to $38,700 and qualify for free care, the hospital said.

Tonkinson said the new cap on expenses is intended to help those who become overwhelmed by big hospital bills in proportion to their family income.

"We want to lift some of that burden," he added.

Tonkinson said the hospital is applying the new guidelines retroactively, going back a full year to find those patients who didn't qualify for help before – but may qualify now.

However, he added, nobody will get a refund under the expanded program. The retroactive discounts and write-offs will apply only to unpaid bills.

In its last fiscal year, Carle hospital provided about $2 million in free or discounted care, with that figure reflecting actual hospital costs. In that last year, the Community Care program helped about 1,800 patients, the hospital said.

Tonkinson said there's no limit on the amount of additional assistance Carle will provide under the new guidelines, as long as the patients qualify. But the hospital has estimated expanding the guidelines will help an additional 560 patients and result in $800,000 to $1 million more in charity care a year.

Champaign County Health Care Consumers Executive Director Claudia Lennhoff said Carle hospital is showing leadership and demonstrating a good understanding of local community needs with the new policies.

"We'd be hard-pressed to find, in terms of discounted care, a hospital that is doing better or having more generous policies around the nation," she said. "I would say this really puts Carle Foundation Hospital on the map as having a very good program and being responsive to the community."

However, she added, local consumers should note that, while the new policies will provide some relief from hospital bills, they won't help with the bills that come from for-profit Carle Clinic, whose doctors care for many of the patients at Carle Hospital.

"I think we still have a lot of challenges with the clinic and consumers need to be aware that these good, new, generous policies apply only to the bills that come through Carle Foundation Hospital," Lennhoff added. "Carle Clinic is another matter."

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