Overview

The Howard Memorial Hospital Financial Assistance Policy exists to provide partially or fully discounted emergent or medically necessary hospital care to eligible patients. This is a summary of the Howard Memorial Hospital (HMH) Financial Assistance Policy (FAP).

Availability of Financial Assistance

Patients will be considered for full or partial charity based on their ability to pay and the Federal Poverty Guideline issued and updated annually. The FAP only applies to services billed by HMH. Other services that are separately billed by other providers, such as physicians, are not eligible under FAP.

Eligibility Requirements

Financial assistance is determined by household income compared to the Federal Poverty Guideline (FPG). Uninsured patients will be given an automatic discount equal to 60% applied to hospital charges. No person eligible for financial assistance under the FAP will be charged more for medically necessary care than amounts generally billed (AGB) to individuals who have insurance covering such care. HMH determines the amount generally billed (AGB) on all claims paid to HMH by Medicare and private health insurers (including payments by Medicare beneficiaries or insured individuals) over a 12-month period, divided by the applicable gross charges for those claims. If an individual has sufficient insurance coverage or assets available to pay for care, he/she may be deemed ineligible for financial assistance. 

Please refer to the full financial assistance policy below for details.

Where to Obtain Information

There are numerous ways individuals may obtain information about the FAP application process or obtain copies of the FAP or FAP application form:

• Click to Download the Application in English Here
• Click to Download the Application in Spanish Here
   
• Request the information by telephone by calling HMH’s Financial Counselor at 870-845-4400.
   
• Visiting the Admissions Office located at the main entrance of Howard Memorial Hospital Monday through Friday 6:30 a.m. to 5:30 p.m.

Availability of Translations

The FAP, FAP application form, and this Plain Language Summary will be prepared in English and Spanish.

Howard Memorial Hospital will provide an automatic discount from the hospital’s regularly billed charges to those patients who do not have insurance. This includes patients whose financial situation normally would not qualify them for charity care discounts. 

Uninsured patients will be given an automatic discount equal to 60% applied to regularly billed charges for emergent and medically necessary care. No person eligible for financial assistance under the FAP will be charged more for medically necessary care than amounts generally billed (AGB) to individuals who have insurance covering such care.  Howard Memorial Hospital determines amount generally billed (AGB) on all claims paid to Howard Memorial Hospital by Medicare and private health insurers over a 12-month period, divided by the applicable gross charges for those claims. If an individual has sufficient insurance coverage or assets available to pay for care, he/she may be deemed ineligible for financial assistance. 

Howard Memorial Hospital has calculated the current AGB to be 40% of regularly billed charges. Therefore, Howard Memorial Hospital will provide the discount from regularly billed charges equal to a 60% discount.

The method for calculating the Amount Generally Billed for individuals with insurance covering emergency or other medically necessary care is the look back method. Howard Memorial Hospital reviewed claims during the 12 month period for the calculation. An explanation how this percentage was calculated is available free of charge by contacting Howard Memorial Hospital Monday through Friday, 8:00 am to 4:30 pm 870-845-4400.   

Definitions

Uninsured - Patient (or guarantor) has no third party payer source at time of service.

Underinsured - Patient (or guarantor) has a third party payer source at time of service, but does not have the financial means to pay the balance after insurance.

Presumptive Charity – Determination that a patient is eligible for charity when the information provided from the patient is inadequate and alternate sources are used to determine that patient qualifies for charity.

If a patient does not have health insurance or is experiencing financial difficulties on the patient portion of the bill and anticipates that he may not be able to pay the balance due, Howard Memorial Hospital offers financial assistance (Charity Care Discount).

The completed application and supporting documentation can be taken to one of the Financial Counselors during normal business hours. Click below to print the Charity Care Patient Financial Statement and complete a Financial Assistance Application. 

• Click to Download the Application in English Here
• Click to Download the Application in Spanish Here

The Federal Poverty Guidelines for income are the basis for determining eligibility for charity discounts. For example, individuals with incomes below 100% of the Federal Poverty Guidelines may be eligible for free care. Individuals with incomes greater than 100% of the Federal Poverty Guideline may be eligible for care at discounted rates depending on their income level and the amount due to HMH.

In addition, Howard Memorial Hospital may review asset information related to the patient’s Financial Assistance Application.   

In order to be eligible for Charity Assistance, a Charity Care Patient Financial Statement must be completed and submitted with the requested documentation. The requested documents include:

• Completed Charity Care Patient Financial Statement
• Current Federal Income Tax Return with all tax schedules
• Pay Check stubs for the most recent 3 months for all members of the household
• Most recent bank statement for all accounts. 

The Charity Care Patient Financial Statement will be evaluated according to the patient’s income compared to the Federal Poverty Guidelines.

The Federal Poverty Guidelines in effect as of January 12, 2022 are provided below:

The calculation for Charity Care Financial Assistance is based on the size of the patient’s immediate family, annual household income, and a sliding scale comparing household income with the federal poverty income guideline. This sliding scale can be obtained from the Financial Counselor at Howard Memorial Hospital.  Contact information is provided below.  

If requested documentation for the Charity Assistance is not available, patient (or guarantor) may contact Financial Counselor to determine alternate sources of support to determine eligibility. 

Charity Assistance will be effective for a period of 12 months subsequent to approval unless evidence is received regarding a change in income, family size, or financial situation that would make the Financial Assistance / Charity Care eligibility no longer valid.

Patient or guarantor receiving less than 100% Financial Assistance / Charity Care must set up a payment plan for the remaining balance. The remaining balance is expected to be paid in full within six months, but alternate payment arrangements with the patient or guarantor can be made.  

Presumptive Eligibility for Charity will be considered when a patient appears eligible for charity, but the Charity Care Patient Financial Statement is incomplete or lacks requested documents. Howard Memorial Hospital will make a decision on Presumptive Charity Care based on: 

• 3rd party score based on Federal Poverty Guidelines
• Patient is deceased with no known estate
• Patient is homeless or Bankruptcy. 

After Howard Memorial Hospital makes a determination that a patient or guarantor is eligible for financial assistance, the patient or guarantor is notified in writing of the eligibility, the dollar amount of the eligibility, the basis for the determination, and the amount that the patient or guarantor owes for the care.

Howard Memorial Hospital will refund to the patient or guarantor any amount he has paid before financial assistance eligibility is determined if the amount already paid exceeds the amount that the patient qualifies for as an eligible individual.    

Howard Memorial Hospital offers charity to patients with Medicaid as primary payer on billable patient charges.

Howard Memorial Hospital has providers, other than the hospital facility itself, that deliver emergency or medically necessary care at Howard Memorial Hospital. The listing specifies which providers are and which providers are not covered by Howard Memorial Hospital’s Financial Assistance Plan. 

Providers Covered under Howard Memorial Hospital’s Financial Assistance Policy:

Providers Not Covered under Howard Memorial Hospital’s Financial Assistance Policy:

Specialty Clinic Physicians (Satellite Clinic)