Western Reserve Hospital is committed to providing education to patients and guarantors as it relates to billing and collections of payment for services rendered. Payment on accounts will be pursued consistently, regardless of race, age, gender, ethnic background, national origin, citizenship, primary language, religion, education, employment or student status, disposition, relationship, insurance coverage, community standing, or any other discriminatory differentiating factor. To that end, Western Reserve Hospital will not engage in any extraordinary collection actions (as defined herein) against an individual to obtain payment for care before reasonable efforts have been made to determine whether the individual is eligible for assistance for the care under its Healthcare Financial Assistance (“HFA”) Policy.
Every guarantor will be given reasonable time and communication to be aware of and understand their financial responsibility. The guarantor will be held financially responsible for services actually provided and adequately documented. Western Reserve Hospital representatives and/or its designee will widely publicize its HFA policy by, among other things, offering a copy of the plain language summary of the policy prior to the patient being discharged. Understanding each guarantor’s insurance coverage is the responsibility of the guarantor. Any self-pay liability secondary to insurance coverage is defined by the guarantor’s insurance coverage and benefit design. Western Reserve Hospital relies on the explanation of benefits and other information from the guarantor and the insurance carrier for eligibility, adjudication of the claim, and patient responsibility determinations.
Western Reserve Hospital offers various options for uninsured and underinsured patients who do not qualify for financial assistance under its HFA policy. For further information, please see the following Western Reserve Hospital policies, or contact Western Reserve Hospital as indicated on Page 5:
• Western Reserve Hospital Financial Aid Catastrophic Policy
A statement of hospital services is sent to the patient/guarantor in incremental billing cycles. In cases when the patient has no insurance coverage, that is a self-pay patient, the statement is sent after services are rendered. In most cases when patients have coverage through an insurance carrier, the statements are sent after the services have been rendered, claim is submitted, and claim has been adjudicated by the insurance carrier. There are some cases, for example, when there is a stop in the adjudication of a claim due to the patient needing to provide additional information, where a statement will be sent to the patient and/or guarantor prior to claim processing.
Western Reserve Hospital representatives and/or their designees may attempt to contact the patient/guarantor (via telephone, mail, or email) during the statement billing cycle in order to pursue collections. Collection efforts are documented on the patient’s account.
The statement cycle will be measured from the first statement sent to the patient (date sent) and include the following:
Subsequent statements sent to the patient/guarantor in increments to derive at the statement process:
- 1st – Date of first billing
- 2nd –14 Days post
- 3rd – 35 Days post
- 4th – 70 Days post and notice of submission to Collection Agency if amounts left unpaid or HFA application not received
- 5th – 120 Days post – Submission to Collection Agency (letter sent from Collections), subject to the provisions of this policy
Extraordinary Collection Actions (ECAs):
- It is the policy of Western Reserve Hospital not to engage in ECAs against an individual to obtain payment for care before making reasonable efforts to determine whether the individual is eligible for assistance under its HFA policy.
- ECAs include:
- Selling a patient’s debt to another party;
- Reporting adverse information about the individual to consumer credit reporting agencies or credit bureaus;
- Deferring or denying, or requiring payment before providing, medically necessary care because of an individual’s nonpayment of one or more bills for previously provided care covered under Western Reserve Hospital’s HFA policy; or
- Actions requiring legal or judicial process, such as commencing a civil action against an individual and placing a lien on an individual’s property (although exceptions include filing a proof of claim in bankruptcy and hospital liens on personal injury judgments/settlements).
- Western Reserve Hospital may pursue all available means in the collection of delinquent accounts including those actions requiring a legal or judicial process. However, legal action will NOT include bank garnishment, repossession of assets and foreclosures. Western Reserve Hospital must be notified of and approve of any legal action being taken in the collection of delinquent accounts by any vendors working on behalf of Western Reserve Hospital.
Efforts to Determine HFA Eligibility:
- Western Reserve Hospital will allow patients to submit complete HFA applications during a 240-day Application Period (as described herein).
- Western Reserve Hospital will not engage in ECAs against the patient or guarantor without making reasonable efforts to determine the patient’s eligibility under the HFA policy. Specifically:
- Western Reserve Hospital will notify individuals about the HFA policy as described herein before initiating any ECAs to obtain payment for the care and refrain from initiating such ECAs for at least 120 days from the first post-discharge billing statement for the care.
- If Western Reserve Hospital intends to pursue ECAs, the following will occur at least 30 days before first initiating one or more ECAs:
- Western Reserve Hospital will notify the patient in writing that financial assistance is available for eligible individuals, identifies the ECAs the facility (or other authorized party) intends to initiate to obtain payment for the care, and states a deadline after which such ECAs may be initiated that is no earlier than 30 days after the date that the written notice is provided; The above notice will include a plain language summary of the HFA policy; Western Reserve Hospital will make a reasonable effort to orally notify the patient about the HFA policy and how the individual may obtain assistance with the application process.
- If Western Reserve Hospital aggregates an individual’s outstanding bills for multiple episodes of care before initiating one or more ECAs to obtain payment for those bills, it will refrain from initiating the ECAs until 120 days after it provided the first post-discharge billing statement for the most recent episode of care included in the aggregation.
- If Western Reserve Hospital defers or denies, or requires a payment before providing, medically necessary care to an individual with one or more outstanding bills for previously provided care, Western Reserve Hospital will provide the individual with an HFA application form and a written notice indicating that financial assistance is available for the eligible individuals and stating the deadline, if any, after which Western Reserve Hospital will no longer accept and process an HFA application submitted (or, if applicable, completed) by the individual for the previously-provided care. The deadline will be no earlier than the later of 30 days after the date that the written notice is provided or 240 days after the date that the first post-discharge billing statement for the previously-provided care was provided. Western Reserve Hospital will also provide the individual with a plain language summary of the HFA policy with the written notice, and make a reasonable effort to orally notify the individual about Western Reserve Hospital’s HFA policy and about how the individual may obtain assistance with the HFA application process. If an HFA application is timely received by Western Reserve Hospital, it will process the application on an expedited basis.
Processing HFA Applications:
If an individual submits an incomplete HFA application during the application period, Western Reserve Hospital will:
- Suspend any ECAs to obtain payment for the care; and
- Provide the individual with a written notice that describes the additional information and/or documentation required under the HFA or HFA application form that must be submitted to complete the application and that includes the Western Reserve Hospital contact information set forth on Page 5.
If an individual submits a complete HFA application during the application period, Western Reserve Hospital will:
- Suspend any ECAs to obtain payment for the care;
- Make an eligibility determination as to whether the individual is HFA-eligible for the care and notify the individual in writing of the eligibility determination (including, if applicable, the assistance for which the individual is eligible) and the basis for this determination.
If the individual is determined to be HFA-eligible for the care, Western Reserve Hospital will:
- If the individual is determined to be eligible for assistance other than free care, provide the individual with a billing statement that indicates the amount the individual owes for the care as an HFA-eligible individual and how that amount was determined and states, or describes how the individual can get information regarding, the AGB for the care.
- Refund to the individual any amount he or she paid for the care (whether to Western Reserve Hospital or any other party to whom Western Reserve Hospital has referred to sold the individual’s debt for the care) that exceeds the amount he or she is determined to be personally responsible for paying as an HFA-eligible individual, unless such excess amount is less than $5 (or such other amount published in the Internal Revenue Bulletin).
- Take all reasonably available measures to reverse any ECA (with the exception of a sale of debt) taken against the individual to obtain payment for the care.
When no HFA application is submitted, unless and until Western Reserve Hospital receives a HFA application during the Application Period, Western Reserve Hospital may initiate ECAs to obtain payment for the care once it has notified the individual about the HFA policy as described herein.
Anti-Abuse Rule – Western Reserve Hospital will not base its determination that an individual is not HFA-eligible on information that Western Reserve Hospital has reason to believe is unreliable or incorrect or on information obtained from the individual under duress or through the use of coercive practices.
Determining Medicaid Eligibility – Western Reserve Hospital will not fail to have made reasonable efforts to determine whether an individual is HFA-eligible for care if, upon receiving a complete HFA application from an individual who Western Reserve Hospital believes may qualify for Medicaid, Western Reserve Hospital postpones determining whether the individual is HFA-eligible for the care until after the individual’s Medicaid application has been completed and submitted and a determined as to the individual’s Medicaid eligibility has been made.
No Waiver of HFA Application – Obtaining a signed waiver from an individual, such as a signed statement that the individual does not wish to apply for assistance under the HFA policy or receive the notifications described herein, will not itself constitute a determination that the individual is not HFA-eligible.
Final Authority for Determining HFA Eligibility – Final authority for determining that Western Reserve Hospital has made reasonable efforts to determine whether an individual is HFA-eligible and may therefore engage in ECAs against the individual rests with the Western Reserve Hospital Patient Financial Services Department.
Agreements with Other Parties – If Western Reserve Hospital sells or refers an individual’s debt related to care to another party, Western Reserve Hospital will enter into a legally binding written agreement with the party that is reasonably designed to ensure that no ECAs are taken to obtain payment for the care until reasonable efforts have been made to determine whether the individual is HFA-eligible for the care.
Providing Documents Electronically – Western Reserve Hospital may provide any written notice or communication described in this policy electronically (for example, by email) to any individual who indicates he or she prefers to receive the written notice or communication electronically.
Financial counselors are available to answer your questions about payment arrangements, insurance coverage, Medicare and other financial inquiries.
For more information about financial counseling, please call:
- Western Reserve Hospital (330) 971-7597.
Patient Account Services
Contact Western Reserve Hospital Patient Account Services at (330) 255-3101.
Representatives are available Monday through Friday from 8:00 a.m. to 12:00 p.m. and from 1:00 p.m. to 4:30 p.m.
Notice to Ohio Residents—Ohio Hospital Care Assurance Program (HCAP): Western Reserve Hospital provides, without charge to the individual, basic, medically necessary hospital-level services to individuals who are residents of Ohio, are not Medicaid recipients, and whose income is at or below the federal poverty line. Covered services are inpatient and outpatient services covered under the Ohio Medicaid Program, with the exception of transplantation services and services associated with transplantation. Recipients of Disability Financial Assistance qualify for assistance. Ohio residency is established by a person who is living in Ohio voluntarily and who is not receiving public assistance in another state. Requests for financial assistance for Ohio residents are processed for HCAP first, and then are otherwise subject to the provisions of this HFA policy.