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As part of its commitment to serve the community, Baylor Health Care System facilities provide financial assistance in the form of charity care to patients who are indigent and satisfy certain requirements.
Baylor Health Care System requires that each patient applying for charity care complete a Financial Assistance Application Form ("Assistance Application") as required by State Law.
Effective on July 1, 2009
Calculation of Family Members
Baylor will request that patients applying for charity care verify the number of people in the patient's household.
Adults: In calculating the number of people in an adult patient's household, include the patient, the patient's spouse, and any *dependents as defined by the Internal Revenue Service ("IRS")
Minors: In calculating the number of people in a minor patient's household, include the patient, the patient's mother, *dependents of the patient's mother, the patient's father, and *dependents of the patient's father.
Calculation of Income Patients must provide their household's yearly income.
Adults: If the patient is an adult, the term "Yearly Income" means the sum of the total yearly gross income of the patient and the patient's spouse.
Minors: If the patient is a minor, the term "Yearly Income" means the sum of the total yearly gross income of the patient, the patient's mother and the patient's father.
Income VerificationBaylor will request that the patient or responsible party verify the patient's Yearly Income reported in Section A of the Assistance Application ("Reported Income"). The Reported Income may be verified through any of the following mechanisms:
Income IndicatorsBy the provision of third party financial documentation including IRS Form W-2, Wages and Tax Statement; pay check remittance; individual tax return; telephone verification by employer of the Patient's Reported Income; bank statements; Social Security payment remittance, Worker's Compensation payment remittance; unemployment insurance payment notice; Unemployment Compensation Determination Letters; or other appropriate indicators of the Patient's Reported Income.
Participation in a Public Benefit ProgramBy the provision of documentation showing current participation in a public benefit program such as Medicaid; County Indigent Health Program; AFDC; Food Stamps; WIC; TexCare Partnership; or other similar indigency related programs.
Other Resources Each patient's situation is evaluated according to relevant circumstances such as the assets or other resources available to the patient to pay for care.
If you are eligible to receive charity care, the level of assistance will be based on a classification as financially indigent, medically indigent, or catastrophic medically indigent.
Financially Indigent means an uninsured or underinsured patient whose total Reported Income is less than or equal to 200% of the Federal Poverty Guidelines (FPG). These Financially Indigent patients are eligible for a 100% discount.
Example Scenario - A patient with number in household of 3 and total Reported Income less than or equal to $36,620 is eligible for a financial assistance discount of 100%.
Medically Indigent means a patient whose medical or hospital bills after payment by all third parties exceed a specified percentage of their total Reported Income (ranging from 5%-10%) and who is unable to pay the remaining bill. These Medically Indigent patients are eligible for a discount ranging from 40%-90% as set forth in Baylor's Financial Assistance Eligibility Discount Guidelines. However, in no case will a patient's balance due after discount is applied be more than 10% of patient's yearly income.
Example Scenario - A patient with number in household of 4 and total Reported Income of $90,000 (450% of FPG) is eligible for a charity care discount of 50% if the patient's total outstanding bill after all third-party payments exceeds 10% of total Reported Income. Assuming the patient's outstanding obligation is $10,000 (which is greater than 10% of total Reported Income), the patient is eligible for a 50% discount ($5,000). The patient's remaining obligation would be 50% ($5,000).
Catastrophic Medically Indigent means a patient whose medical or hospital bills after payment by all third parties exceed 50% of the patient's total Reported Income and the patient is unable to pay the remaining bill. These Catastrophic Medically Indigent patients are eligible for a discount ranging from 65%-90% as set forth in Baylor's Financial Assistance Eligibility Discount Guidelines.
Example Scenario - A patient's outstanding obligation is $90,000 and total Reported Income is $80,000. The patient is eligible for a 90% discount as catastrophically indigent. The patient's eligible for a discount of $81,000 and the patient's remaining obligation would be $9,000.
In certain situations, it may be appropriate to grant a patient charity care even though the patient's financial situation does not satisfy the requirements set forth in Baylor's Financial Assistance Eligibility Discount Guidelines. In these situations, the Assistance Application and other pertinent information may be reviewed by the Baylor Charity Care Committee and a determination will be made as to the patient's eligibility for charity care. If you have any questions about your specific situation, please contact the appropriate Baylor hospital for assistance.
*Dependents Definition for Calculation of Family Members - Can include children or step-children (minor or adult), grandchildren, great grandchildren, siblings, half-siblings, step-siblings, step-parents, grandparents, nieces or nephews, aunts or uncles, son-in law or daughter-in-law, mother-in-law or father-in-law, brother-in-law or sister-in-law.
According to IRS regulations, for someone to be considered a dependent on another individual's tax return, over one-half of the dependent's total support for that year must have been furnished by the taxpayer and the dependent must have less than $3,200 of gross income (for 2005) unless they are under age 19 (or under 24 and a full-time student). The annual gross income is adjusted annually by the IRS.
Additionally, if someone in the household is not one of the relatives listed above, then in order to be claimed as a dependent they must meet the income test, the greater than 50% support test and during the taxpayer's entire tax year, live in the taxpayer's home. However, they can not be a dependent if the relationship between the person and the taxpayer is in violation of local law.
Reservation of RightsBaylor Health Care System reserves the right to exclude certain services from the Baylor Health Care System Charity Care Policy. Baylor Health Care System also reserves the right to limit or deny financial assistance to patients at the sole discretion of Baylor Health Care System.
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