Financial Assistance

Financial Assistance or Payment Plans

If you anticipate problems paying your portion of your bill, please let us know. We can help you apply for other types of financial assistance or payment plans. For an explanation of the hospital financial assistance policy please click here to download the Financial Assistance Policy Application and see the Plain Word Summary below.  For more information please review the Corry Memorial Hospital Charity Care Policy.

Rates and Basis for Financial Assistance

If you qualify for financial assistance, discounts in the form of Charity Care are applied. See the Financial Assistance Income Scale in the Hospital Charity Care policy. 

• View our non-discrimination notice.
• View our language assistance services.

Patient Notice of Financial Aid

Corry Memorial Hospital is proud of its mission to provide quality care to all who need it, 24 hours a day, 7 days a week, 365 days a year.

If you do not have health insurance or worry that you may not be able to pay for part or all of your care, we may be able to help. Corry Memorial Hospital provides financial aid to patients based on their income, assets, and financial needs. In addition, we may be able to help you get free or low-cost health insurance or work with you to arrange a manageable payment plan.

Federal and state laws require all hospitals to seek payment for care provided from individual’s health insurance or when individuals have the financial means to pay for care. This means Corry Memorial Hospital could ultimately turn unpaid bills over to a collections agency, which could affect your credit status. Therefore, it is important that you let us know as soon as possible if there may be a problem paying your bill so that it can be determined if our charity care and financial aid programs would apply to you.

In order to qualify for our Community Care Program you must meet these requirements:

• Applied for Medical Assistance and be denied
• Family Income Guidelines related to number of dependents in family and/or assets
• Medical Necessity of Services

Should your situation change, you may reapply for financial assistance before, during or after care or after collection agency assignment.

For more information, please contact our financial counseling office at 814-664-4641. We will treat your questions and any information you provide us with confidentiality and courtesy.

Copies of our Financial Assistance Policy are available on our website at or in person at 965 Shamrock Lane, Corry, PA.

Corry Memorial Hospital Community Care (Charity Care) Financial Assistance Policy (FAP)

Effective Date: April 14, 1997

Review Dates: June 2004, July 2010, January 2011, June 2016

Revision Dates: June 2004, May 2006, April 2009, December 2011, January 2013, June 2016

Approved By: Approved by Board of Trustees Oct 17, 2007: Approved by Board, December 2, 2016
(Signatures of multidisciplinary personnel involved in policy and procedure development.) 

POLICY:

Corry Memorial Hospital (CMH), a non profit organization, was established to serve the healthcare needs of the citizens of Corry and the surrounding areas. The Hospital is committed to providing medical services to patient regardless of their ability to pay. It is also the policy of CMH to charge every patient for services rendered. However, CMH does recognize that all patients do not have the financial resources to pay their hospital bill. The purpose of this policy is to define and outline charity care options, via CMH Community Care Financial Assistance Policy (FAP), for patient’s lacking other financial resources.

CMH will calculate the amount to charge patients by the look-back method to determine the Amount Generally Billed. (ABG) The ABG% is 60% of charges which was calculated by taking the average reimbursement from all contracted payers.

After the determination of FAP eligibility the FAP – eligible individual may not be charged more than the ABG for emergency or other medically necessary care.

A financial counselor is available Monday- Friday from 8:00am- 4:30pm, excluding holidays, as well as other appointments as necessary to assist in applying for financial assistance. The Financial Counselor can be reached by calling (814) 664-4641 ext. 7406 and is located in the billing office at the main hospital campus.

APPLICABILITY:

CMH and Corry Medical Services (CMS)

DEFINITIONS:

FAMILY UNIT: A FAMILY UNIT IS DEFINED AS ONE OR MORE PERSONS RELATED BY BIRTH, MARRIAGE, OR ADOPTION WHO LIVE TOGETHER.

INCOME INCLUDES: WAGES AND SALARIES BEFORE DEDUCTIONS, NET INCOME FROM SELF-EMPLOYMENT, SOCIAL SECURITY, RETIREMENT INCOME, UNEMPLOYMENT COMPENSATION, WORKER’S COMPENSATION, DISABILITY  COMPENSATION, PENSIONS, STRIKE BENEFITS, PUBLIC ASSISTANCE, ALIMONY, CHILD SUPPORT, DIVIDENDS, INTEREST, RENTAL INCOME, GAMBLING AND LOTTERY WINNINGS.

LIQUID ASSETS INCLUDES: ASSETS SUCH AS BANK ACCOUNTS, CD’S AND INVESTMENTS IN PUBLICLY TRADED SECURITIES (STOCKS, MUTUAL FUNDS, ETC), ANNUITIES AND/OR TRUST FUNDS MAY ALSO BE CONSIDERED WHEN DETERMINING ELIGIBILITY UNDER THIS PROGRAM.

INCOME VERIFICATION: INCOME VERIFICATION SHALL INCLUDE COPIES OF PAY STUBS, TAX RETURNS, BANK STATEMENTS AND OTHER RECORDS THAT MAY BE REQUESTED TO VERIFY INCOME

WRITE-OFF AMOUNT: THE TOTAL WRITE-OFF AMOUNT SHALL BE BASED ON A SLIDING FEE SCALE FOR GROSS CHARGES OF ALL SERVICES, COVERED THROUGH THE CMH COMMUNITY CARE POLICY (FAP), AND WITH DATES OF SERVICE WITHIN THE DEFINED CMH COMMUNITY CARE (FAP) APPROVAL PERIOD.

PROCEDURES:

1. PATIENT HANDOUTS: All patients requesting consideration under the CMH Community Care (FAP) policy will be presented with the “CMH Community Care Qualification Process”, “CMH Community Care Guidelines” AND the “CMH Community Care – Patient Financial Application.”
2. APPLICATION TIMEFRAME: Application must be completed and received by the hospital within 45 days from receipt by patient. 
3. PREREQUISITES: An uninsured patient who is not able to pay for services will be eligible to apply for CMH Community Care. A determination of a patient’s ability to pay will be determined during the financial counseling process or review of the completed application with supporting documentation. Eligibility requirements will be based on the following patient criteria:
   • Medical Assistance Denial (a)
   • Family Income Guidelines related to number of dependents in family and/or assets
   • Medical necessity of services
     • The Financial Counselor will provide assistance in completing the Medical Assistance application via COMPASS and assist in obtaining forms necessary for determination by the Department of public Welfare. Financial Counselor will also assist in applying for other types of insurance programs such as CHIPS.
     • A Medical Assistance denial is not required for a patient who ceases to breathe while in the hospital. Additionally, any uninsured patient who expires within 60 days of the date of service will be evaluated to determine if a Medical Assistance application is necessary for CMH Community Care approval.

   Please note: Any patient who does not cooperate in all efforts to obtain other available assistance will waive his or her rights to CMH Community Care program.

4. APPLICATION REVIEW: Completed applications should be forwarded to the Patient Finance Department for determination of eligibility and are reviewed by the end of month following of the receipt of the completed application.
5. PATIENT FINANCE REVIEW: Patient Finance will review the CMH Community Care (FAP) APPLICATION, complete the “Hospital Use Only” section, prepare the appropriate adjustment worksheets (for approved applications – see approval process below), and notify the patient of the determination.
6. CMH COMMUNITY CARE APPROVAL TIMEFRAME AND EXCLUSIONS: Approvals for CMH Community Care will be effective for accounts related to the current course of treatment, not to exceed 90 days. The approval is limited to medically necessary services provided by CMH or CMS and does not apply to private physician services, dental services, cosmetic services, prescriptions, or personal items such as television or telephone, etc. CMH Community Care approval for private physicians must be approved by the applicable physician office.

7. APPROVAL PROCESS:

   All Applications

   Manager, Patient Finance
   CFO Approval

   Greater than $5,000
   CEO Approval

   Greater than $10,000
8. CMH COMMUNITY CARE CAP: The hospital reserves the right to determine the maximum amount of CMH Community Care benefits granted in a given fiscal year.
9. INCOME GUIDELINE TABLE: Exhibit A will be utilized to determine the amount of Community Care. Setting forth these Community Care guidelines will be updated annually to coincide with the Federal Poverty levels as published in the Federal Register.
10. Other supporting files for this policy:
    

    File Name	Documents included:
    CMH Community Care Guidelines (two)	CMH Community Care Guidelines (Handout)
    CMH Community Care App and Letters (three)	CMH Community Care – Patient Financial Appl.
    CMH Community Care – Approval Letter	CMH Community Care – Denial Letter

11. Nonpayment -In the event of nonpayment the hospital may take action to obtain payment including, but not limited to, any extraordinary collection actions (ECA’s). The public may obtain a copy of the Credit and Collection Policy by contacting the billing department at (814) 664-4641 or on the hospital website at www.corryhospital.com.

CMH COMMUNITY CARE GUIDELINES

You may be eligible to receive services at Corry Memorial Hospital at no charge if your family unit meets the following requirements:

• Medical Assistance Denial
• Family Income Guidelines related to number of dependents in family and/or assets
• Medical Necessity of services

Your family unit income must be at or below the amount listed in the table to be eligible for a reduction in service cost. CMH reserves the right to deny Community Care if in its discretion it appears that the family assets are sufficient to provide resources to pay for services rendered.

Family Unit: A family unit is defined as one or more persons related by birth, marriage, or adoption who live together.

Income: All income from all sources such as wages and salaries before deductions, net income from self employment, social security, retirement income, unemployment compensation, worker’s compensation, disability compensation, pensions, strike benefits, public assistance, alimony, child support, dividends, interest, rental income, gambling, lottery winnings, etc.

Assets: Includes cash, savings and checking accounts, certificate of deposits, securities (stocks, bonds, mutual funds, etc.), annuities and/or trust funds, pension accounts, residence (fair market value), all other real estate (FMV), automobiles (make, model, year), etc.

Eligible services are those services not covered by any other third party insurance coverage. If you feel that you may be eligible for services under the CMH Community Care program, please complete the attached second page of application and present it to any registration representative or mail it to the Patient Finance Department.

INCOME GUIDELINES based on Poverty Guidelines
(EFFECTIVE February 6, 2017, in the Federal Register)

FAMILY SIZE	150% of poverty Full allowance	200 % of poverty 75% allowance	250% of poverty 50% allowance	300% of poverty 25% allowance
1	$18,090	$24,120	$30,150	$36,180
2	$24,360	$32,480	$40,600	$48,720
3	$30,630	$40,840	$51,050	$61,260
4	$36,900	$49,200	$61,500	$73,800
5	$43,170	$57,560	$71,950	$86,340
6	$49,440	$65,920	$82,400	$98,880
7	$55,710	$74,280	$92,850	$111,420
8	$61,980	$82,340	$103,300	$123,960
FOR EACH ADDITIONAL FAMILY MEMBER, ADD:	$6,270	$8,360	$10,450	$12,540

 

Non-Discrimination Notice

LECOM Health Corry Memorial Hospital complies with the nondiscrimination provision in Section 1557 of the Patient Protection and Affordable Care Act (ACA). This law prohibits discrimination by covered health programs on the basis of race, color, religion, national origin, sex, age, gender identity or expression, sexual orientation, AIDS or HIV status, pregnancy genetic information or disability.

LECOM Health Corry Memorial Hospital does not exclude people or treat them differently because of their race, color, religion, national origin, sex, age, gender identity or expression, sexual orientation, AIDS or HIV status, pregnancy, genetic information or disability. LECOM Health Corry Memorial Hospital provides free aids and services to people with disabilities to communicate effectively with us, such as: 

• Qualified sign language interpreters
• Language services to people whose primary language is not English

If you need these services, please contact the Discharge Planning Department at LECOM Health Corry Memorial Hospital. If you believe that LECOM Health Corry Memorial Hospital has failed to provide these services or discriminated in another way on the basis of race, color, religion, national origin, sex, age, gender identity or expression, sexual orientation, AIDS or HIV status, pregnancy, genetic information or disability you can file a grievance with:

LECOM Health Corry Memorial Hospital

965 Shamrock Lane

Corry, PA 16407

Attention: Trisha Sawyer

(814) 664-4641

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights or to the Pennsylvania Civil Rights office by mail, phone or email at:

Office for Civil Rights U.S. Department of Health and Human Services

200 Independence Avenue, SW

Room 509F, HHH Building

Washington, D.C. 20201

1-800-868-1019 TDD: 1-800-537-7697

https://ocrportal.hhs.gov/ocr/portal/lobby.jsf

Pennsylvania Office of Civil Rights Division of Acute & Ambulatory Care Room 532 Health & Welfare Building 625 Forster Street Harrisburg, PA 17120-0701

(717) 783-8990

Fax: 717-705-6663

Complaint Hotline: 1-800-254-5164