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Sometimes a child's illness, injury or chronic condition can challenge a family's finances. Cook Children's Northeast Hospital offers help for uninsured or underinsured children by offering financial assistance options.
To describe how Cook Children's Northeast Hospital (CCNH) will allocate resources for emergency and other medically necessary care provided at CCNH to patients who need financial assistance, and to manage CCNH's limited resources to appropriately provide medically necessary care to:
The CCNH primary service area is comprised of Tarrant, Johnson, Parker, Denton, Hood, and Wise counties.
In connection with CCNH's exemption from certain federal and the state taxes, and in support of CCNH's mission to serve the health care needs of the community, CCNH will provide financial assistance to eligible patients in accordance with this Financial Assistance Policy (FAP).
Information about financial assistance will be widely publicized and made available to guarantors whose children have received care from CCNH.
Financial assistance may be granted to United States (U.S.) citizens or lawful permanent residents who are not residents of the CCNH primary service area within the limitations of this policy. Applications for financial assistance will be approved in accordance with the levels of authority indicated in this policy. The approving individual(s) will review and document that all applicable policies were followed.
Financial assistance will be available to all individuals who receive services at CCNH on an emergency basis and do not have the resources to pay for the services, regardless of residency or citizenship status.
Financial assistance will be granted, if qualified, without regard to age, sex, gender identity or expression, sexual orientation, physical or mental disability, race, creed, ethnicity, religion, language, or national origin.
CCNH is required to make a reasonable effort to determine whether an individual is eligible for financial assistance in accordance with the terms of this policy. Financial assistance will be determined as soon as possible. For scheduled services, when it may become apparent that financial assistance is needed, an application for financial assistance should be provided along with any assistance needed to complete the process. It is the goal of CCNH to make an eligibility determination as soon as possible after all information is collected in the application process.
A person who is eligible for financial assistance will never be charged more for emergency or other medically necessary care than the amounts generally billed to individuals with insurance.
There may be unique situations when a guarantor may have a financial hardship, but not meet the requirements of this policy to receive financial assistance.
This FAP does not apply to, and a patient may be billed separately for, services provided by certain physicians that are not employed by one of Cook Children's Health Care System's (CCHCS's) affiliated entities and/or other non- hospital providers. Refer to Attachment A for a list of providers and services that are not covered under this FAP. This list will be reviewed quarterly for accuracy and updated as appropriate.
Family- A group of two or more persons related by birth, marriage, or adoption; all such related persons are considered members of one family. For instance, if an older married couple, their daughter and her husband and two children, and the older couple's nephew all lived in the same house or apartment, they would all be considered members of a single family.
Unrelated individual- A person 15 years old or over (other than an inmate of an institution) who is not living with any relatives. Examples of unrelated individuals residing with others include a lodger, a foster child, a ward, or an employee.
Household- A household consists of all the persons who occupy a housing unit (house or apartment), whether they are related to each other or not. If a family and an unrelated individual, or two unrelated individuals, are living in the same housing unit, they would constitute two family units, but only one household.
Income- Total annual cash receipts before taxes from all sources, with the exceptions noted below. Income includes money wages and salaries before any deductions; net receipts from self- employment; regular payments from social security, railroad retirement, unemployment compensation, strike benefits from union funds, workers' compensation, veterans' payments, public assistance and training stipends; alimony, child support, and military family allotments or other regular support from an absent family member or someone not living in the household; private pensions, government employee pensions (including military retirement pay), and regular insurance or annuity payments; college or university scholarships, grants, fellowships, and assistantships; and dividends, interest, net rental income, net royalties, periodic receipts from estates or trusts, and net gambling or lottery winnings.
Exclusions From Income- Income does not include the following types of money received: capital gains, any assets drawn down as withdrawals from a bank, the sale of property, a house, or a car, tax refunds, gifts, loans, lump-sum inheritances, one-time insurance payments or compensation for injury, or non-cash benefits.
Resident- An individual who is either a U.S. citizen or a lawful permanent resident and lives in the CCHCS primary service area. A lawful permanent resident is issued an alien registration card, an I-551 card, which is better known as a “green card.” Persons in the U.S. on any valid visa are not considered residents.
Undocumented Immigrant- A non-citizen who enters the U.S. without inspection or who overstays his/her visa. Also referred to as "person not lawfully present," " illegal alien," or "illegal immigrant."
CCNH will widely publicize information in this FAP by:
Except for individuals that are admitted to CCNH on an emergency basis, to be eligible for financial assistance, the individual must be a resident of either Denton, Hood, Johnson, Parker, Tarrant, or Wise County, or he/she must be a patient of a physician that has an established relationship with CCHCS.
Patients may not be covered under this financial assistance policy if they are covered by a commercial insurance company that:
Patients are also ineligible if they do not provide all required information to CCNH or to their insurance company. If the family chooses to receive non-emergency care for their child(ren) at CCNH, even though they know the services will not be covered, the family will be responsible for payment of the estimated amount of the claim in full prior to service.
If it is determined that a patient may qualify for a government-sponsored program such as Medicaid, Children's Health Insurance Program (CHIP), Children with Special Health Care Needs (CSHCN), or Supplemental Security Income (SSI), but the family refuses to apply for assistance, the bill will not be considered for financial assistance. The family will be responsible for the entire balance and payment of the estimated amount at the time of the services.
Elective cosmetic procedures may not qualify for financial assistance. Elective cosmetic procedures must be approved in advance by the Administrator or his/her designee.
Information regarding the amount of financial assistance provided by CCNH each fiscal year is aggregated and reported to the Texas Department of Health in the America Hospital Association (AHA)/Department of Health and Human Services (DHHS)/Texas Hospital Association (THA) Annual Survey of Hospitals (cooperative annual survey). It is broken down into two sections: The American Hospital Association Annual Survey and the Texas Department of Health Survey Supplement.
U.S. Department of Treasury proposed regulations See [4830-01-p] DEPARTMENT OF THE TREASURY Internal Revenue Service, 26 CFR Part 1, [REG-130266-11], RIN 1545-BK57, Additional Requirements for Charitable Hospitals, AGENCY: Internal Revenue Service (IRS), Treasury, page 52, released June 26, 2012.
Financial assistance form
Formulario de assistencia financiera
Providers Not Covered by this Financial Assistance Policy:
Catastrophic Eligibility - Insured Patients or Patient's Income exceeds 500% of Federal Poverty Guidelines (also applies to Medically indigent).
Balance due must be equal to or greater than 35% of the patient's gross annual household income.