(A) Application.
(1) An application for without charge service will be taken when a patient requests without charge service only after credit information is taken and it appears that the patient may be eligible for without charge service. Staff may request without charge service for patients whose financial ability to pay is questionable. A signed application must be on file in order for an account to be approved for without charge service.
(2) If credit information has not been documented and the application will be based on income, a current credit information sheet shall be completed.
(3) Upon receiving the application, the billing service will review the application and make recommendations to the Director according to the eligibility criteria set forth in division (B) below.
(B) Eligibility. A patient will be eligible for consideration for without charge services if he or she meets any of the following and has shown proof that he or she has met any recommendations by billing staff.
(1) Annual income is below the Federal Poverty Guidelines.
100% of Poverty Level Medicaid Scale
|
100% of Poverty Level Medicaid Scale
| |
Size of Family | Monthly Income |
1 | $776 |
2 | 1,041 |
3 | 1,306 |
4 | 1,571 |
5 | 1,836 |
6 | 2,101 |
7 | 2,366 |
8 | 2,631 |
Each additional person | 265 |
(2) Eligible for Kentucky Medicaid and has no other identifiable means of making payment for the balance of services not covered by KMAP.
(3) Eligible for Kentucky Medicaid must apply.
(4) In addition, a patient shall be considered for without charge service is any in- depth financial investigation reveals any of the following:
(a) The is no ability to pay or available assets.
(b) Patient has expired and has no distributable estate.
(c) All available assets are committed to some other essential cause.
(C) An award letter will be sent to the requester informing him or her that he or she has been approved, approved conditionally, delayed for further information, or denied. Patients who have had their accounts approved will not be sent a bill. Bills will be continued until such time that the account has received the approval of the Director of the Ambulance Service or his or her designee where applicable as stated in the without charge policy.
(D) Exceptions. The Ambulance Service will reserve the right to deny full or partial without charge services to anyone who:
(1) Does not qualify under the above guidelines.
(2) Does not follow through with any referral made by Ambulance Service billing staff to an outside agency in attempting to obtain payment from a government source such as Medicaid.
(3) Abuses/misuses the system.
(4) Does not have a medical condition which is determined to be an emergency that requires ambulance transportation.
(5) Requests non-emergency transportation but does not have a medical condition that precludes other means of transportation.
(Ord. 0-04-020, passed - -04)