In keeping with TMC HealthCare’s commitment to our community and our mission to deliver caring, personalized, quality health care, services are made available to all patients regardless of ability to pay. When appropriate, Tucson Medical Center staff can determine if a patient account qualifies for community care. Below is the full policy, approved by the TMC HealthCare Board of Trustees in December 2015, used to help patients with financial obligations owed to Tucson Medical Center.

Click on the links below for a pdf file of English and Spanish versions of the financial assistance policy, the summary of the program and the application.

English      Español
Financial Assistance Policy Política de Asistencia Financiera
Patient Financial Assistance Summary Resumen del Programa de Asistenecia Financiera
Financial Assistance Application   Asistencia Financiera Solicitud

Tucson Medical Center Financial Assistance Policy

DEFINITIONS

  1. Community Care and Financial Assistance Process is in keeping with TMC HealthCare’s commitment and mission to deliver caring, personalized, quality health care services to all patients regardless of ability to pay. True self-pay patients, those denied for pre-existing conditions, those not eligible on dates of service or with non-covered benefits with the exception of elective package pricing automatically receive a discount. When appropriate, TMC HealthCare staff should determine if a patient account qualifies for community care.
  2. Services provided to patients when payment is not anticipated because of an inability to pay - Financial assistance is available through Tucson Medical Center’s “Financial Assistance Policy” (FAP) program. This policy is also known as our Community Care Policy. The FAP is separate and distinct from bad debts, which are accounts in which credit has been extended and payment is anticipated, but not received. Following the determination of FAP eligibility, an FAP-eligible individual will not be charged more for emergency or other medically necessary care than the amounts generally billed (AGB) to individuals who have insurance covering such care. The methodology used by TMC to calculate AGB is the Look-back Method. Members of the public may readily obtain the current AGB percentage and a description of how it is calculated by contacting TMC Patient Financial Services, (520) 324-1310.
  3. The Financial Assistance Policy applies only to charges associated with services provided by Tucson Medical Center. Charges for services provided by practitioners practicing at TMC, but not employed by TMC, are not covered by this policy.

MEDICALLY NECESSARY

Refers to inpatient or outpatient health care services provided for the purpose of evaluation, diagnosis and/or treatment of an injury, illness, disease or its symptoms, which otherwise left untreated would pose a threat to the patient’s ongoing health status. Services must be clinically appropriate and within generally accepted medical practice standards, represent the most appropriate and cost-effective supply, device or service that can be safely provided and readily available at Tucson Medical Center with a primary purpose other than patient or provider convenience. Expressly excluded from medically necessary services are: health care services that are cosmetic, experimental, part of a clinical research program, private and/or non-TMC medical or physician professional fees, or services and/or treatments not provided at a TMC. 

PURPOSE

To further the Tucson Medical Center mission to the communities it serves, TMC will provide financial assistance for medically necessary health care in a fair, consistent, respectful and objective manner to low-income patients who do not have insurance coverage or are underinsured. 

POLICY

Consistent with its mission statement, Tucson Medical Center will provide available and necessary health care services, including for emergency medical conditions to patients, regardless of their disability, sexual orientation, age, sex, race, religion, creed, national origin or ability to pay.

TMC assists eligible persons without insurance coverage or who are underinsured by waiving all or part of the charges for services provided by TMC. 

APPLICATION FINANCIAL ASSISTANCE DETERMINATION AND PAYMENT

  1. Completion of the Community Care application – Patients wishing to apply for financial assistance must complete a Community Care application within 30 days of discharge. Otherwise, a patient will continue to be billed. A copy of the Community Care application may be obtained on the hospital’s website at www.tmcaz.com/community-care-policy or by calling the TMC Business Office, (520) 324-1310. Completion includes filling out and submitting a Community Care application, along with all requested documentation of income and assets, to P.O. Box 42195, Tucson, AZ 85733 or by fax, (520) 324-3004. Documentation provided with the completed Community Care application must include, as applicable: copies of Social Security cards; proof of residency; bank or credit union statements for the last three months; investment statements for the last three months; W-2s or other wage or income information such as three months of payroll stubs, Social Security checks, unemployment checks, self-employment business records, income award letters/grant of education benefits, or other documents showing income and assets; a copy of current IRS tax return; mortgage statements and annual property tax statements; and documents evidencing the relationships of household members, including birth or baptismal certificates, adoption papers, marriage license, divorce decree or legal separation documents. TMC may request additional documentation during its application review process.
  2. Incomplete application – An incomplete Community Care application may be denied until or unless it is completed. TMC will retain the incomplete application for six months and send a letter to the patient outlining the information needed and how to submit the necessary paperwork.
  3. Confidentiality - TMC keeps confidential all Community Care applications and supporting documentation.
  4. Eligibility Determinations - The TMC Business Office will review the patient applications and inform patients via mail of the results within 30 days of receiving a completed application and all requested documentation. Final determination for financial assistance is provided to the patient in a written notice of determination (NOD). Assignment to a collection agency for follow-up will not occur during the assistance determination process.
  5. Payment arrangements after financial assistance determination - TMC will continue to work with patients to resolve the remainder of their balance after a financial assistance determination has been made. Patients are responsible to make mutually acceptable payment plan arrangements with TMC within 30 days of their NOD (See payment plans).
  6. Patient default notification - of transfer to a collection agency after payment plan arrangements - TMC will send a minimum of two monthly statements to patients who have failed to make payment arrangements after NOD or who do not comply with mutually agreed payment plans. The notice will alert the patient of the balance, and if the patient’s financial situation has changed, the patient may have the opportunity for a new payment plan. The notice will also alert the patient that the matter may be sent to a collection agency if it is not resolved. This communication will take place prior to transfer to a collection agency.
  7. Collection activities - Patients who have completed an application and are under review will have collection activity put on hold pending the decision.
  8. Late completion of an application - Patients may apply for financial assistance at any time.

COLLECTION PRACTICES FOR COMMUNITY CARE PATIENTS

  1. TMC will continue to bill the patient for at least 120 days if the patient does not make payment arrangements or fails to initiate the financial assistance process. Collection activities, including transferring to a collection agency, will begin on accounts older than 120 days. TMC will send a minimum of three statements every 30 days prior to transferring an account to a collection agency. TMC will make two phone calls on accounts with returned mail in an attempt to contact the patient at the address and phone numbers provided by the patient. If there is no response the account will be transferred to a collection agency. Statements and communications will inform the patient of the amount due, the opportunity to complete an FAP application, and that the completion of the application may qualify the patient for free or reduced-cost care.
  2. Accounts older than 241 days in self-pay and that have been referred to a collection agency may be reported to a credit bureau agency.
  3. Agencies contracted with TMC will provide patients the TMC 24-hour phone number that patients may call to request financial assistance if financial assistance is requested by the patient while in collections.
  4. Patients whose accounts have been transferred to a collection agency may request TMC financial assistance, submit a Community Care application with requested documentation and be considered for reduction of their bill. These patients will be subject to a stay-of-collection activities described in the preceding paragraph.
  5. Patients sent to collections and who are making payments will not be reported to the credit bureau. 

ELIGIBILITY CRITERIA FOR PATIENT FINANCIAL ASSISTANCE UNDER THE FAP

  1. The Community Care Policy employs a sliding-scale discount that takes into consideration a patient’s household income and assets.
  2. Eligible patients are uninsured or underinsured persons who receive inpatient or outpatient medically necessary services from any TMC location and both the following apply:
    i. They are not eligible for coverage that would otherwise pay for these services (whether through employer-based coverage, commercial insurance, government-sponsored coverage or third-party liability coverage.)
    ii. They have household incomes (as defined below) below 400 percent of the Federal Poverty Level (See FPL Grid) for the 12 months preceding the date of services.
  3. Financial assistance determinations will be consistent among patients regardless of their age, sex, race, religion, creed, disability, sexual orientation, national origin or immigration status.
  4. Financial assistance is generally secondary to all other financial resources available to the patient, including insurance, government programs, third-party liability and qualified assets.
  5. Individuals with access to health insurance, third-party reimbursement for health services or governmental assistance who refuse to enroll, fail to take advantage of, or fail to maintain eligibility for such coverage may be excluded from receiving financial assistance.
  6. Hospital Community Care application information may be used for a period of six months for qualification. After six months, a new application may be required to qualify new services for charity.
  7. Community Care applications will be reviewed and approved within the limits stated as follows:

Patient Financial Services Rep.

$0 - $3,000

Supervisor

$3,001 - 10,000

Patient Financial Services Manager

$10,001 - $25,000

Director of Revenue Cycle Services

$25,001 and over

 

FINANCIAL ASSISTANCE DETERMINATION PROCESS

  1. The qualifying level of assistance for patients eligible for Community Care will be based on TMC’s billed charges. Patients that qualify under the Community Care Policy will not be charged more than the amounts generally billed (AGB) for services rendered. AGB is calculated annually by determining the average percentage paid for services rendered to Medicare and private insurance payers. A copy of this calculation is available upon request by calling the Business Office, (520) 324-1310. Thereafter, financial assistance will be determined using a sliding-fee scale based upon household income as compared with the Federal Poverty Level (FPL) and subject to a reduction based on qualifying assets.
  2. In order to obtain financial assistance, the patient must establish (through completion of an FAP application and submission of required documentation) that the patient’s household income is below 400 percent of the FPL.
  3.  Allowances may be made for extenuating circumstances based on each person’s unique life situation and mitigating factors. The amount of assistance provided by TMC may be more than outlined in the TMC FPL Grid for the current year but not less.
  4.  Documents used for income and assets verification for the household include but are not limited to: copies of the most recent 90 days of payroll stubs, Social Security checks or unemployment checks; copy of the current IRS tax return filed; current bank, trust fund statements, mortgage statements and annual property tax statements. In the absence of income, a letter of support from individuals providing for the patient’s basic living needs may be provided. Upon request TMC may require additional verification of income and assets.

PAYMENT PLANS FOR FINANCIAL ASSISTANCE PATIENTS

  1.  Guidelines for payment plan amounts are outlined below:

    Amount Owed

    Months to Pay

    $75-250

      3

    $251-500

      5

    $501-1,000

      7

    $1,001-2,000

    13

    $2,001-3,000

    18

    $3,001-4,000

    22

    $4,001-5000+

    24

    If a payment plan needs further extension,
    please contact the TMC Business Office.

  2. Community Care patients meeting an agreed upon monthly payment plan will not be assigned to a collection agency.
  3. Patients are responsible for communicating to the Business Office anytime an agreed upon payment plan may be broken. Lack of communication from the patient may result in further account collection action after appropriate patient notification.
  4. Payment plans extending beyond the recommended timeframe are accepted based on supporting documentation or adequate security with manager approval.
  5. Payment plans extending beyond the recommended time frame with no supporting documentation may be forwarded to the collection agency for extended payments. These may be interest-free with no legal action pursued as long as the payment plan is maintained.

APPEALS OF ASSISTANCE DETERMINATIONS

Patients or their representatives may appeal a financial assistance determination by providing additional information demonstrating eligibility, such as income verification or an explanation of extenuating circumstances, to the business office within 30 days of receiving the NOD. The Patient Financial Services Manager and the Director of Patient Financial Services will review all appeals. The responsible party will be notified of the outcome.

ACCOUNTING FOR CHARITY CARE 

  1. A separate file will be maintained for accounts written off as charity care and retained in the Business Office for a minimum of two years.
  2. Staff will use the “Approval of Application for Charity Care” form when the receivable is approved for write-off.

COMMUNICATION TO PATIENTS

  1. TMC is committed to making the people in the communities it serves aware of the availability of financial assistance through its Community Care Policy. TMC will provide financial counseling to patients upon request and help those who are eligible through the Community Care application process.
  2. TMC communicates the availability of financial assistance in appropriate acute-care settings such as Emergency departments, registration areas and on the hospital website.
  3. All billing statements and statements of services will inform patients that financial assistance is available.
  4. Signs are posted in hospital registration areas informing patients that financial assistance is available for qualifying patients who complete an assistance application. These signs inform patients that free or reduced-cost care maybe available to qualifying patients who complete an application.
  5. Materials describing the Community Car Policy, including cards and brochures, are available in English and Spanish on the hospital website, in Admitting and at the Business Office.
  6. Financial counseling and Business Office personnel are available at the hospital or at the Business Office to assist patients in understanding and applying for local, state and federal health care programs and the TMC Community Care.
  7. Reasonable efforts are made to ensure that all TMC employees are informed about how to refer patients to apply for TMC Community Care. Annual staff education programs are provided to all Business Office and Admitting staff.
  8. Patients can request financial-assistance information or a copy of this policy or the Community Care application by calling the Business Office, (520) 324-1310. Voicemail is available and calls will be followed up within two working days.
  9. Patients are provided information regarding the availability of financial assistance upon registration or admission to TMC’s acute-care areas.
  10. This policy and the Community Care application for assistance in the form of the TMC FAP are available on the TMC website at www.tmcaz.com/community-care-policy, in acute-care inpatient registration areas or via mail from the Business Office. The Community Care application documents include instructions on how to complete the application form and the kinds of supporting documentation that are needed to complete the application process. Instructions for return of the form are also provided.
  11. Individuals other than the patient, such as the patient’s physician, family members, community or religious groups, social services, or hospital personnel, may make requests for financial assistance on a patient’s behalf.