Financial Assistance Policy
The following is a summary of UPMC's Financial Assistance Policy, effective Oct. 10, 2011. This is a general overview of the policy; UPMC will review each application individually to determine whether that patient and treatment qualify for financial assistance.
UPMC's policy is to provide financial assistance for patients who:
- Have limited or no health insurance.
- Have applied for governmental assistance, such as Medicare or Medicaid, but did not qualify.
- Demonstrate financial need.
- Reside in the primary service area of a UPMC provider.
- Supply UPMC with necessary information about household finances.
Financial assistance is available for eligible patients who require:
- Emergency medical services
- Nonelective services for urgent life-threatening conditions, outside the Emergency Department
- Other medically necessary services, on a case-by-case basis
Depending on the individual’s need, either free care or reduced patient financial obligations to UPMC hospitals or physicians may be offered. UPMC does not have the authority to waive any charges from physicians or other health professionals who are not employed by UPMC.
UPMC is committed to publicizing its Financial Assistance Program broadly within the communities it serves.
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
- Up to the resolution of his or her account
Determination of Eligibility for Financial Assistance
To request financial assistance, you can submit the UPMC Financial Assistance Application form (formulario de Solicitud de Asistencia Financiera) , disclosing household income and expenses. For nonemergency 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. You are an important part of this process. Please provide UPMC with the necessary paperwork, when requested.
Typically, you will not be eligible for UPMC financial assistance until you have applied for and been deemed ineligible for federal and Commonwealth of Pennsylvania governmental assistance programs. As a result, UPMC may make resources available to assist you in enrolling in or applying for such programs. UPMC reserves the right to process the Financial Assistance Application without this determination, provided enough information is available to make an accurate assessment of the patient’s financial situation.
Determination of Assistance Amount
In determining a reasonable and fair level of assistance, UPMC applies a sliding scale.
If a patient’s income is below 400 percent of the federal poverty guidelines, the patient may receive some form of financial assistance.
|At or below 200 percent of the federal poverty guidlines:
||The patient is eligible for 100 percent financial assistance. The fees for UPMC services are completely waived.|
|Between 201 and 400 percent of the federal poverty guidelines:
||The patient is eligible for an 85 percent reduction in charges from UPMC hospitals and physicians— in other words, the patient pays 15 percent of the charges.|
UPMC will not charge an eligible individual for emergency or other medically necessary services more than the amount generally billed (AGB) to individuals who have insurance covering such care.
In some cases, UPMC may recognize other financial or medical conditions that warrant financial assistance. If your income falls outside the guidelines listed above, please contact UPMC's Financial Assistance Department at 1-800-845-1745 in order to review the circumstances. In any case, UPMC staff may be able to help establish a payment plan that helps patients pay their balance over time.
While UPMC’s Financial Assistance Program covers most services, there are some exclusions, such as, but not limited to:
- Cosmetic services
- Transplant-related services
- Bariatric-related services
- Elective reproductive services
- Private duty nursing
- Dental services
- Services deemed noncovered by Medicare
- Other services, at UPMC's discretion
Financial assistance is not typically available for:
- Insurance copayments
- People who fail to reasonably comply with insurance requirements, such as obtaining authorizations or referrals
In addition, this policy does not apply to international patients who come to Pennsylvania in order to seek treatment from a UPMC provider.
If you have questions or would like to apply for Financial Assistance, please call 1-800-371-8359.