Adm. Policy Number: 1.64
Effective Date: January 1, 2026
SUBJECT: Financial Assistance Policy (FAP)
SPONSOR: Patient Accounting
PURPOSE:
The purpose of this policy is to provide patients with information on the Heritage Valley Health System (HVHS) Financial Assistance Policy (the “Policy”). The Policy outlines the process for determining a patient’s eligibility for financial assistance related to their medical bill at HVHS, the types of financial assistance available to qualified patients, and the services that are included and excluded under this Policy. The Policy also details the billing and collection practices for patients eligible for financial assistance.
SCOPE:
The mission of HVHS is to provide individuals in the community with access to medical care, including those with limited financial resources. HVHS is committed to providing necessary health care services at no charge, or reduced charges, to patients who are willing to meet their financial obligations but do not have or cannot obtain adequate financial resources.
This Policy applies to all emergency and other medically necessary care provided by HVHS hospitals.
DEFINITIONS:
Amounts Generally Billed (AGB): AGB is defined as the amounts generally billed for emergency or other medically necessary care to individuals who have insurance covering such care. HVHS uses the Prospective Medicare method to determine AGB for emergencies or other medically necessary care. As a result of this calculation, an uninsured patient will not be charged more than the AGB for emergency or other medically necessary care.
The public may readily obtain information regarding the AGB and the manner in which it is calculated in writing and free of charge by submitting a request, in writing, to the following address:
Patient Accounting Department
Heritage Valley Health System
200 Ohio River Blvd.
Baden, PA 15005
Emergency Medical Condition: Defined within section 1867 of the Social Security Act (42 U.S.C. 1395dd). An emergency medical condition is defined as a medical condition manifesting itself by acute symptoms of sufficient severity such that the absence of immediate medical attention could reasonably be expected to result in placing the health of the individual in serious jeopardy, serious impairment to bodily functions, or serious dysfunctions of any bodily organ or part.
Extraordinary Collection Actions (ECAs): Defined to include actions such as selling debt to another party, reporting adverse information to consumer credit reporting agencies, or taking actions that require a legal or judicial process (e.g., placing a lien on property, garnishing wages, or commencing a civil action).
Financial Assistance: Full or partial adjustment of charges for services provided to patients by HVHS hospitals, determined by program eligibility, which is based on HVHS qualification criteria.
Income: Family income shall include salaries, wages, unemployment compensation, social security income, and other forms of taxable income. The approval guidelines are based on Federal Poverty Guidelines (FPG) as established and updated annually by the Department of Health and Human Services.
Medical Hardship: For purposes of this Policy, an individual whose responsible balances, after exhaustion of all liquid assets, insurance, and other third-party benefits, meet or exceed 25% of the individual’s Annual Income, shall be deemed to have suffered a Medical Hardship.
CRITERIA FOR QUALIFYING (AND PROCESS FOR OBTAINING) FINANCIAL ASSISTANCE:
1. Overview of the Process
Patients who seek Financial Assistance will engage in a series of important steps:
- A. Patient Obtains an Understanding of the Criteria for Qualification.
- B. Patient Completes the Application Process.
- C. HVHS Completes Financial Assistance Determination.
- D. If Approved, Financial Assistance is Applied to the Patient Account.
2. Criteria for Qualification and Financial Assistance Available
Types of Services Covered:
Financial Assistance will only apply to emergencies and other medically necessary services. Cosmetic or elective surgical procedures deemed non-medically necessary are not eligible for the Charity Care program. Charity care determinations apply only to hospital services (technical charges) and Emergency Room Physicians; they do not apply to radiologists or other professional services not billed by hospital staff.
Financial Requirement Threshold Criteria and Calculation:
There are three principal financial criteria applied as follows to determine whether a patient has economic means to pay and whether the patient meets eligibility for Financial Assistance under this Policy, assuming other Policy criteria are also met.
- Liquid Assets: First, a patient’s liquid assets are determined. If liquid assets exceed the calculated threshold, all liquid assets above the threshold must first be used to satisfy any outstanding balance owed to HVHS by a patient. Liquid assets exclude your primary residence, one vehicle, and basic retirement funds.
- Income Threshold (200% Rule): Once step one has been completed, if the patient still owes a balance, then the patient will be evaluated on an income basis.
- If the patient and/or guarantor’s household income is at or below 200% of the Federal Poverty Level (FPL) Guidelines, then 100% of the balance for which the patient is still responsible will be forgiven by HVHS.
- No Financial Assistance is available for a patient or a guarantor whose Annual Income is greater than 200% of the FPL unless they qualify under Medical Hardship as described below.
- Medical Hardship: As an alternative to step 2, a patient may demonstrate Medical Hardship. Patients who meet Medical Hardship criteria qualify for the same Financial Assistance benefit as individuals whose income is at or below 200% of the FPL Guidelines. Generally, HVHS does not provide Financial Assistance to patients whose income exceeds 200% of the FPL unless they meet the criteria for Medical Hardship.
Once qualified, an individual remains eligible for Financial Assistance for 6 months before having to re-qualify. Individuals who qualified prior to January 1st, 2026, will remain eligible for 12 months from the date of approval.
3. Application Process
Patients generally must complete the Charity Care Application form to be considered under the Policy.
Timeline for Applications (240 Days):
Applications must be received within 240 days from the date that HVHS first sent a post-discharge billing statement to the patient (the “application period”). Failure by the patient to submit a complete application within such application period may result in a denial of Financial Assistance.
Initial Period After Discharge:
During the period that extends 120 days past the date of the first post-discharge billing statement (120-Day Period), HVHS and the patient will endeavor to resolve the patient’s obligation, without the use of Extraordinary Collection Actions (ECAs), such as credit reporting, lawsuits, or debt sales.
- If the patient has failed to submit an application for Financial Assistance by the end of the 120-Day Period, HVHS may engage in ECAs for purposes of collecting on the patient account, provided that proper notifications have been made to the patient.
- However, HVHS will accept and process applications submitted by an individual during the longer application period that ends on the 240th day after HVHS provides the patient with the first post-discharge billing statement.
Submission:
To request financial assistance, patients will complete the Financial Assistance application and provide their household income. If the information on the application is found to be incomplete, the application will be returned to the patient with a letter indicating what information is required. Proof of all liquid assets must also be submitted if a Medical Hardship request is undertaken.
Contact Information:
Patients can obtain a copy of the Financial Assistance application through our website at www.hvhs.org. Alternatively, you may call our office at 412-749-4200 or 724-773-5681 to have the application mailed to you. Completed Financial Assistance applications should be directed to:
Patient Accounting Department
Heritage Valley Health System
200 Ohio River Blvd.
Baden, PA 15005
4. Financial Assistance Determination
HVHS shall promptly process all requests for Financial Assistance. All applications will be reviewed and approved or denied within a reasonable time after they are considered to be complete. All patients who apply for Financial Assistance shall be notified of the final determination in a plain-language letter. If the patient does not qualify for Financial Assistance, as defined in the Policy, the patient shall be expected to pay the full amount of
their patient responsible balances, which may result in copayments, deductibles, and coinsurance. For uninsured patients, AGB shall be used to determine the amount the patient is responsible for, as defined elsewhere in the Policy.
5. Presumptive Eligibility Determination
HVHS understands that, in rare circumstances, some patients may be unable to complete a Financial Assistance application, and/or comply with requests for documentation. As a result, there may be circumstances under which a patient’s qualification for Financial Assistance is established without completing the formal Financial Assistance application. At HVHS’s sole discretion, we reserve the right to determine presumptive eligibility for patients who are non-responsive to the original request and to complete the Financial Assistance application.
In determining presumptive eligibility, HVHS may use scoring software to determine if the patient has the ability to pay. A patient may qualify for the HVHS Charity Care program if the presumptive eligibility score indicates a low propensity to pay, along with other supporting factors evaluated during the Financial Assistance process.
6. Certain Aspects of Billing and Collections as They Relate to Financial Assistance
HVHS strives to obtain all appropriate third-party reimbursement. When coverage is unavailable or none is in effect, HVHS expects the patient to pay the appropriate amount. All patients will be subject to HVHS’s normal billing procedures until they engage in the Financial Assistance process, and a determination is made that they are eligible for Financial Assistance.
FINANCIAL ASSISTANCE REPORTING:
HVHS shall comply with all federal, state, and local laws, rules, and regulations and reporting requirements that apply to activities conducted pursuant to this Policy.
PUBLICATION OF THE POLICY:
This Policy, along with an application form, is available on the HVHS website (www.heritagevalley.org). Paper copies are available upon request and at no charge in designated public locations, including the Patient Accounting Department and the Emergency Room. Each billing statement references Heritage Valley’s Charity Care Program to help the recipient satisfy the debt.