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Financial Assistance Policy

Purpose

Some Montana Pediatrics patients will not have the financial means to pay for the care provided to them by Montana Pediatrics providers. This may be the case even when a portion of the bill for those charges is paid for by a governmental healthcare program, like Medicare and Medicaid, or a healthcare benefits plan such as insurance or a health share program. For that reason, Montana Pediatrics provides Financial Assistance to eligible patients by covering up to 100% of the billed amount that the patient is personally responsible to pay, which is called the”Self-Pay Balance” in this policy. In order to provide guidance to Montana Pediatrics’ patients, their caregivers, the public, and Montana Pediatrics’ staff about Financial Assistance, Montana Pediatrics has adopted this policy and related procedures. This policy and related procedures are intended to meet the requirements of Internal Revenue Code section 501(r).

Policy

  1. Part of Montana Pediatrics’ mission is expanding access to care and providing care to patients without regard to the ability to pay. Patients will not be denied access to Montana Pediatrics services based upon a financial inability to pay for such services. Montana Pediatrics will provide Financial Assistance to eligible patients for the cost of care provided by Montana Pediatrics providers.
  2. Montana Pediatrics is committed to providing this financial assistance to its patients who are unable to pay the Self-Pay Balance based on their individual financial situations.
  3. Patients will not be responsible for paying for more care than the Amounts Generally Billed (AGB) to individuals who have insurance covering that same care, therefore the patient’s Self-Pay Balance will not exceed the AGB.
  4. Information and assistance about how the policy may apply to a particular patient’s situation may be obtained via this policy or by calling our office at 406-272-4631

Procedure

  1. Any patient, as well as the patient’s responsible party, who receives care from Montana Pediatrics providers is eligible to seek Financial Assistance.
  2. Financial Assistance may include up to 100% coverage of the Self-Pay Balance, including, where appropriate and when legally permissible, balances related to the copayment, coinsurance, and deductible for patients.
  3. Montana Pediatrics will reasonably require a patient seeking Financial Assistance to complete an application process by submitting limited information to qualify for Financial Assistance.
  4. Patients who do not affirmatively ask for Financial Assistance, but who may qualify for Financial Assistance, may be separately identified through the information they provide prior to receiving care, which includes primary and secondary insurance and credit card information.
    1. Patients are identified as potentially eligible for Financial Assistance as follows:
      1. Patient does not have insurance and…
        1. Does not provide credit card information during the visit, and attempts to collect the self-pay balance have failed (see billing policy)
        2. Indicates through our self-service financial assistance webpage that paying for their visit would be a financial hardship
      2. Patient has insurance and…
        1. Does not provide a credit card during the visit, and attempts to collect the remaining self-pay balance have failed (see billing policy)
        2. Indicates through our self-service financial assistance webpage that paying for their visit would be a financial hardship
      3. Patient contacts Montana Pediatrics through our website or through our billing office to request Financial Assistance ahead of utilizing Montana Pediatrics services
    2. Patients identified as potentially eligible for Financial Assistance will be offered an opportunity to follow this policy to receive Financial Assistance.
  5. Patients will be asked to provide financial information to determine their eligibility for financial aid by submitting such information through our website. Patients will be asked to attest to the prior year’s earnings as well as the number of dependents in the patient’s household, and will also be asked to attest that the patient cannot afford to pay Montana Pediatrics’ charges.
    1. If a Patient’s Family Income is less than 200% of the Federal Poverty Guidelines, the Patient is eligible for a 100% adjustment of up to the amount of the Self-Pay Balance.
    2. If the Patient’s Family Income is more than 200% but less than 400% of the Federal Poverty Guidelines, the Patient is eligible for a partial discount of the Self-Pay Balance, using a sliding scale. The sliding scale will be revised annually as the Federal Poverty Guidelines are updated. Federal Poverty Level Guidelines can be found at https://aspe.hhs.gov/poverty-guidelines
  6. Approval of Financial Assistance:
    1. Patients who meet the eligibility criteria will be afforded the applicable level of Financial Assistance to cover the Self-Pay Balance.
    2. The Montana Pediatrics office staff will report the approval of financial assistance to our billing agency to adjust the self-pay balance accordingly.

Financial Assistance Sliding Scale

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