Adventist Medical Center

FPL = Discount
0-200%=100%

Formula for 201%-400%:
Divide income in excess of AMC’s Income Guideline* by the guideline. Subtract result from total bill, Mul-tiply result by total bill. Bal-ance remaining which is less than this result is free.

Pts must live in hospital service area, and must not be eligible for publicly funded coverage.

Discount covers all pts’ accounts for 3 months, & any services planned dur-ing the subsequent 3 mos.

Available to pts who are uninsured or who cannot pay their portion after in-surance payment. Catas-trophic hospitalization may be sufficient to qualify.

Medically Necessary is as defined by Medicaid & Medicare.

*$19,600 income for a 1 person family, $26,400 for 2, $33,200 for 3; $40,000 for 4. Add $6800 for each additional family member.

Legacy Emanuel, Meridian Park, Mt. Hood, Salmon Creek, Good Samaritan

FPL = Discount
0-200% = 100%
201%-225% = 90%
226%-250% = 80%
251%-275% = 70%
276%-300% = 60%
301%-325% = 50%
326%-350% = 40%
351%-375% = 30%
376%-400% = 25%

Medical indigency combined medical bills 1xs annual salary, catastrophic event/diagnoses, or Medi-caid eligibility within 60 days of service, also may qualify patient for finan-cial assistance.

Patients with open lines of credit indicative of resour-ces to pay bill will not be eligible for financial assistance.

If requested, payment adjustments are available for early bill payment: 10% within 7 days, 5% within 14 days.

Oregon Health and Science University Hospitals & Clinics

FPL = Discount
0-200% = 100%
205-225% = 90%
230-250% = 80%
255-275% = 70%
280-295% = 60%
300-320% = 50%
325-340% = 40%
345-360% = 30%
365-380% = 20%
385-400% = 10%

Available for medically necessary services provid-ed to eligible pts through-out Oregon, and eligible minors living in State of Washington counties adjacent to Oregon.

Eligibility is specific to each in-pt admission. Out-pt services require periodic screening.

OHSU uses OMAP’s list of Priority Medical Services as a guideline for covered services.

Providence Portland,Milwaukie, St. Vincent

FPL = Discount
0-200% = 100%
201-300% = 70%
301-350% = 40%
351-400% = 10%

Automatic Uninsured Discount adjusts bill to rate charged to PHS Preferred Providers.

If bill after discount is a hardship pts may apply for financial assistance.

Pts must have resided in primary service area of a PHS hospital for at least six months AND house-hold income must be 400%FPL for >/= 12 months prior to service.

Pts with access to health insurance, third party reim-bursement for health ser-vices or government pro-grams, but who elect not to enroll, or who fail to maintain coverage may be excluded.

Southwest Washington Medical Center

FPL = Discount
0-200% = 100%
201-225% = 80%
226-250% = 70%
251-275% = 60%
276-300% = 50%
301-325% = 40%
326-350% = 30%
351-375% = 20%
376-400% = 10%
400+% = 0%

Available to uninsured, eligible patients living in hospital’s service area.

Not available to patients with access to health insurance, third party reimbursement for health services or government programs, but who elect not to enroll, or who fail to maintain coverage.

Includes clinic, urgent, emergent, and in-hospital care.

Tuality Healthcare

FPL = Discount
0-219% = 100%
220-239% = 90%
340-259% = 80%
260-279% = 70%
280-299% = 60%
300-319% = 50%
320-339% = 40%
340-350% = 30%
360-379% = 20%
380-399% = 10%
400% = 5%

Not available to patients with access to health insurance, but who elect not to enroll.

Includes services provided by physicians in Tuality medical group.

Willamette Falls Hospital

FPL = Discount
0-220% = 100%
221-240% = 90%
241-260% = 80%
261-280% = 70%
281-300% = 60%
301-320% = 50%
321-340% = 40%
341-360% = 30%
361-400% = 20%

Automatic 20% Uninsured Discount.

If bill after discount is a hardship pts may apply for financial assistance.

Financial assistance is available to insured and uninsured, equally.

Financial assistance eligi-bility will cover related household members for one-year from date com-pleted application was received.

Available for hospital care, outpatient services, and care provided by internal medicine and immediate care clinics.