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Self Pay Policy

Self Pay Policy

For patients presenting to San Gorgonio Memorial Hospital without insurance coverage, a letter will be sent to the patient with the initial billing statement. In accordance with the California Assembly and State bills AB 774, SB 1276, and AB 1503, which are requirements for Fair Pricing Policies and the Charity and Discount payment policies, patients who are residents of California will be screened to the extent possible for consideration in these programs. The initial letter submitted to the patient or the patient’s responsible party will request that the patient contact the Patient Financial Services Department to verify the absence of insurance coverage. Additionally the letter will offer assistance in applying for various local, state and federal insurance programs and provide information related to the agency to contact for the Local Consumer Assistance Center.

Reasonable efforts will be made to notify patient or patient’s responsible party of the financial assistance programs and self pay discounts at the time of service as well as with every billing or statement sent to the patient prior to submitting the account for referral to a collection agency.

Self-Pay discounts will be available for patients that are uninsured, underinsured or where coverage is not available from their insurance company for the service being rendered. All Self-pay patients will be screened for linkage to any appropriate form of assistance, including but not limited to Medi-cal, Covered CA, Healthy Family programs Patients will also be screened for liability from any third party insurance programs, such as Automobile Insurance, Worker's Compensation, Home Owners Insurance, etc. Note: For future or current services at SGMH, the patient may be requested to complete the application process for Covered CA, California Medi-cal, presumptive Medi-cal and/or any other available programs to determine whether healthcare coverage is available to the patient to meet their current and on-going healthcare needs.

Whenever it becomes apparent that the patient or the patient’s responsible party may have difficulty in meeting their financial responsibility to the hospital, based on being uninsured or underinsured, the patient will be offered a Self-Pay discount. In accordance with SB 1276, which expands the availability of charity care and discount payment plans to all patients with high medical costs, pending applications for health insurance coverage does not prevent the patient from being eligible for the hospital's charity care or discount payment program.

In the event that the patient does not qualify for any of the above programs the following generic discount policy will be applied:

Payment at Time of Service

  • Lump sum payment at time of service or within 3 months of the service date, a discount of 50% of billed charges is authorized to be offered. Discount will be applied when payment is made.
  • For patient's requesting a discount but needing to set up a payment plan to meet the payment obligation, a discount of 30% of billed charges is authorized to be offered. Payments should not be stretched over more than 6 months’ time without approval of the Patient Financial Services Director. The discount will be applied when final payment is made.
    • A reasonable payment plan must be offered to all patients meeting the eligibility requirements in situations where an agreement cannot be reached regarding a payment plan during the negotiation process between hospital and patient. This payment plan will require that monthly payments not exceed 10% of a patient's familial income for one month excluding deductions for 'essential living expenses'.
  • Interest is not applied if payment arrangements are made prior to the account being referred to an outside collection agency. Once the account has been transferred to an outside collection agency, standard interest rates will apply through that agency.

Payment for Service after 3 Months from the Time of Service:

  • For lump sum payments after date of service, discounts of between 30% - 50% of billed charges can be offered, the amount of the discount will be determined after taking the patients financial status and the age of the account into consideration. The discount will be applied when payment is made.
    Note: if account is in bad debt, patient must work with bad debt agency to resolve the bill.
  • For patient's requesting a discount, but needing to set up a payment plan to meet the payment obligation, a discount of between 30% - 50% of billed charges is authorized to be offered, The discount will be applied after taking the patients financial status and the age of the account into consideration. Payments should not be stretched over more than 6 months’ time without approval of Patient Financial Services Director. Discount will be applied when final payment is made.
    • A reasonable payment plan must be offered to all patients meeting the eligibility requirements in situations where an agreement cannot be reached regarding a payment plan during the negotiation process between hospital and patient. This payment plan will require that monthly payments not exceed 10% of a patient's familial income for one month excluding deductions for 'essential living expenses'. Note: if account is in bad debt, patient must work with bad debt agency to resolve the bill.
  • Interest is not applied if payment arrangements are made prior to the account being referred to an outside collection agency. Once the account has been transferred to an outside collection agency, standard interest rates will apply through that agency.

Notifications to Patients:

  • At least three statements will be mailed to the patient including but not limited to: the original billing statement with a letter regarding the financial assistance available as well as billing statements reflecting the current balance at minimum once a month following the original statement. These billing statements will include information of how to contact the correct office to request financial assistance for uninsured or underinsured patients. This will occur for 2 or more consecutive months prior to the account being referred for placement at a collection agency and will result in a total of 3 or more written notices. There will be no less than three written notices sent to the patient at the address given at the time of service, unless return mail has been received.
  • Telephone calls will be made to the patient at the telephone number provided at the time of service as well, prior to referring the patient to an outside collection agency.