Financial Assistance Policy
The following is a summary of UPMC's Financial Assistance Policy, effective January 1, 2009. The information on this page provides a general overview of the policy; each application is evaluated individually against the specific qualification criteria.
It is the policy of UPMC to provide financial assistance for
patients who:
- have limited or no health insurance
- have applied for but are deemed ineligible for governmental assistance (for example, Medicare or Medicaid)
- demonstrate financial need
- reside in western Pennsylvania and/or the primary service area of a UPMC provider
- supply UPMC with pertinent information about household finances
Financial assistance applies to emergency care and to services that are considered medically necessary. Depending on the individual’s need, either free care or reduced patient financial obligations may be offered, and may extend to UPMC physician charges as well as UPMC hospital services. UPMC does not have the authority to waive any charges from physicians or other health professionals who are not employed by UPMC.
Each patient has the opportunity to apply for financial assistance at all times throughout his or her relationship with UPMC — prior to treatment, throughout treatment, and up to the resolution of his or her account.
Determination of Eligibility and Assistance Amount
To request financial assistance, patients submit the UPMC Financial Assistance Application form, disclosing household income, assets, and expenses. For non-emergency services, financial counselors will also conduct an interview with the patient before the date of service or discharge.
Applicants are treated with dignity and respect throughout the process; all information is handled with confidentiality. The patient’s cooperation in providing UPMC with necessary information is crucial to the process.
Financial assistance applications are available in the offices of physicians employed by UPMC and in areas where patients are registered at UPMC hospitals, and signage about financial assistance is posted at these locations.
A patient is not eligible for financial assistance until he/she has applied for and been deemed ineligible for federal and Commonwealth governmental assistance programs. As a result, UPMC may make resources available to assist patients in enrolling in and/or applying for such programs. UPMC reserves the right to process the Financial Assistance Application without this determination, provided an accurate assessment of the patient’s financial status can be made with equivalent or sufficient income and asset information.
In determining a reasonable and fair level of assistance, UPMC applies a sliding scale. If a patient’s income and assets combined are below 400 percent of the federal poverty guidelines, the patient will receive some form of financial assistance.
- If a patient’s income and assets combined fall below 200 percent of the federal poverty guidelines, the patient will have no financial responsibility for care provided; the fees for UPMC services are completely waived.
- If a patient’s income and assets combined fall between 201 and 300 percent of the federal poverty guidelines, the patient is eligible for financial assistance in the form of an 80 percent reduction in charges. This means that the fees for UPMC services are limited to a maximum of 20 percent of the charges.
- If a patient’s income and assets combined fall between 301 and 400 percent of the federal poverty guidelines, the patient is eligible for financial assistance in the form of a 70 percent reduction in charges. This means that the fees for UPMC services are limited to a maximum of 30 percent of the charges.
- If a patient’s income and assets combined fall above 400 percent of the federal poverty guidelines, the patient is eligible for financial assistance in the form of a 20 percent reduction in charges. This means that the fees for services are limited to a maximum of 80 percent of the UPMC charges.
While UPMC’s Financial Assistance Program covers most services, there are some exclusions, such as, but not limited to, cosmetic surgery, transplant- and bariatric-related services, elective reproductive services, acupuncture, private duty nursing, dental, and services deemed non-covered by Medicare.
Financial assistance is not typically available for insurance copayments, deductibles, or when a person fails to reasonably comply with insurance requirements (such as obtaining authorizations and/or referrals). Financial assistance is not available for persons who opt out of available insurance coverage. In addition, this policy does not apply to international patients who come to Pennsylvania in order to seek treatment from a UPMC provider.
Quality Assurance
UPMC performs random audits of applicable patient accounts to ensure that financial assistance is communicated and administered in compliance with the terms of this policy. UPMC provides extensive Financial Assistance Policy training and education to UPMC staff. UPMC reviews this Financial Assistance Policy annually for clarity, applicability, and legal compliance.