Patient Assistance Program

• RHMPI financial assistance process includes:
  • Identify patients who are unable to pay for medically necessary healthcare services
  • Completion of Financial assistance application
  • Collection all supporting documentation
  • Notification of the amount of financial assistance
• RHMPI provides the following types of financial assistance for Medically Necessary Services:
  • Universal Exams/Testing
  • Copay Assistance (Prescription Medications, Office Visits, Labs, Other Services)
• Financial assistance will be available on the basis of documented financial need when there are no additional forms of payment available. No patient will be denied Financial Assistance on the basis of age, sex, or sexual orientation, race, religion or national origin.
• RHMPI will provide a copy of the financial assistance application to all patients at time of registration and will be kept on file in the event there is a need for assistance with patient treatment cost/share. This form will be reviewed once the patient requests financial assistance with the request of additional supporting documentation.
• RHMPI will utilize the standardized financial assistance application to review the applicable patient’s account balance, medication adherence, and appointment compliance.
• RHMPI requires each patient applying for financial assistance to cooperate with the standardized application process by providing the required documents as proof there is a reasonable basis for financial assistance such as proof of income, id, and household size.
• RHMPI will also screen uninsured patients for Presumptive Eligibility for financial assistance upon request by the patient. However, if there is a reasonable basis to believe the patient may be eligible for insurance coverage under public programs, or if RHMPI requires documentation to establish a presumptive eligibility category, RHMPI shall allow the patient 30 days to respond to RHMPI and apply for insurance coverage or to produce requested documents.
• RHMPI will approve or deny each application based on all qualifying factors and the patient will be notified regarding.
• RHMPI shall determine approval or denial as soon as possible prior to providing services and prior to the issuance of any bill for such services.
• Each approved patient financial assistance amount will be based on the services being provided.
• All information and completed financial assistance forms will be maintained at RHMPI.

APPLICANT

An individual who has submitted a completed Financial Assistance Application, including all information and documents requested on the Application form.

FAMILY INCOME

The adjusted gross income and cash benefits from all sources before taxes of all persons legally obligated to pay the charges incurred, less payment of child support.

FAMILY SIZE

The aggregate number of personal exemptions allowed under federal tax law on a federal income tax return which was filed or could have been filed for the most recent calendar year and on which the Patient or Guarantor is one of the persons for whom a personal exemption is allowed, unless a Patient can establish a civil union pursuant to state law.

PATIENT

The person who receives care from RHMPI and the person who is the Guarantor of the payment for services received from RHMPI.

UNINSURED PATIENT

A patient not covered under a policy of health insurance and is not a beneficiary under a public or private health insurance, health benefit, or other health coverage program including high deductible health insurance plans, workers’ compensation, accident liability insurance, or other third party liability insurance.

This policy and procedure shall be periodically reviewed and updated consistent with the requirements and standards established by the Board of Directors and the RHMPI CEO, as well as federal and state laws and regulations.