Lewis Health Center

Patient Billing Information

 

Thank you for choosing Lewis Health Center (LHC) for your health care services. The following is important information about the billing process that we hope you find helpful. Should you have any questions, please contact LHC, Monday through Friday, from 8:00 a.m. until 4:30 p.m. at 931.796.4901.

You may receive statements from Family Health Group (FHG). You may also receive separate bills from a radiologist or pathologist. These bills are not generated by LHC, FHG, or MRMC; therefore, you should contact the appropriate entity for inquiries. The following policy is applicable to Lewis Health Center FQHC patients that receive a face-to-face physician visit that includes lab and X-ray at time of the physician visit.

Lewis Health Center FQHC

Discounted/Sliding Fee Policy

It is the policy of Lewis Health Center to provide quality health care regardless of the patient's ability to pay. Discounts are offered based upon household income and size. A sliding fee schedule is used to calculate the basic discount and is updated April 1 using the current federal poverty guidelines. Once approved, the discount will be honored up to one year or through March 31 (whichever comes first) after which the patient must reapply.

Affordable Care is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with LHC’s procedures for obtaining affordable care or other forms of payment or financial assistance, and to contribute to the cost of their care based on their individual ability to pay.

Patients will be required to assign or pay, to the clinic, all insurance payments or liability settlements designated as remuneration for medical expenses.

Credit reports will be pulled when it is necessary to substantiate data on file and will be considered in the approval process.

DEFINITIONS:

Affordable Care: Affordable Care results from a provider’s policy to provide health care services free, nominal charge or at a discount to the individual who meets the established criteria.

Family: A group of two or more people who reside together and who are related by birth, marriage, or adoption. According to the Internal Revenue Service rules, if a patient claims someone as a dependent on their income tax return, they may be considered a dependent for the purposes of the provision of sliding fee discount policy.

Family Income: Family Income is determined using the following guidelines.

  • Includes earnings, unemployment compensation, worker’s compensation, Social Security, Supplement Security Income, public assistance, veteran’s payments, survivor benefits, pension, or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources:
  • Noncash benefits (such as food stamps and housing subsides) do not count;
  • Determined on a before-tax basis;
  • Excludes capital gains or losses;
  • Non-relatives, such as house mates, do not count.
  • Self employed applicants income will be calculated using the most recent federal income tax return

Uninsured: The patient has no level of insurance or third party assistance to assist with meeting his/her payment obligations.

Underinsured: The patient has some level of insurance or third party assistance but still has out-of-pocket expenses that exceed his/her financial abilities.

Any patient that is uninsured/underinsured, are those who are ineligible for any government health care benefit program and who are unable to pay for their care, based upon a determination of financial need in accordance with this Policy. The granting of affordable care (sliding fee) shall be based on an individualized determination of financial need and shall not take into account, age, gender, race, social status, sexual orientation, or religious affiliation.

Discount/Sliding Fee Application Process

A complete application including required documentation of the home address, household income, and insurance coverage must be on file and approved by the Business office before a discount will be granted. If the applicant appears to be eligible for Medicaid, a written denial of coverage by Medicaid may also be required.

Patients must provide proof of income 30 days from date application was given.

LHC shall process requests for sliding fee discounts promptly and will notify the applicant in writing upon their determination.

Once an application has been approved, any visits within 6 months of the dated application with outstanding charges (or no later than March 4, 2014, the effective date of the FQHC status) will be given the sliding fee discount. 

Incomplete applications will be denied.

Each Patient is required to pay a Nominal Fee of $20.00.

Appeals Procedure: If an applicant is denied, the applicant may appeal the denial, in writing, within 30 days of the denial date. Once written appeal is received, the application with be re evaluated by the Business Office Supervisor and/or LHC Controller/LHC Director. A written response to the denial will be provided to the patient and will indicate either approval or the upholding of the denial.

Acceptable Proof of Income Forms Include but are not limited to:

  • Recent check stubs (last two check stubs)
  • W2
  • Signed Letter from employer stating wages (hours and rate of pay)
  • If self-employed, a copy of the most recent federal tax return
  • Social Security Award letter or Current Bank Statement showing deposit
  • Veteran’s pension award letter or copy of Veteran check
  • Letter from social security office stating monthly benefit
  • Child support award letter or court order document
  • Unemployment compensation letter/check
  • Award letter from unemployment office indication weekly benefit
  • Copy of worker’s compensation check
  • Current Food Stamp qualification letter (no older than one year).

Adolescent patients seeking confidential care are exempt from the application process, and services are provided at the nominal rate.

The need for assistance shall be re-evaluated every 12 months or April 1st (whichever comes first) , meaning that visits occurring within 12 months or prior to April 1 of a previous approval will received the approved sliding fee discount.

LHC understands that patient’s financial situations may change; therefore, LHC reserves the right to reevaluate previous sliding fee discount approvals based on more current information. The reevaluations will be handled on case-by-case basis.

No discount will be applied if application is returned incomplete. Incomplete applications will result in a denial of the application.

Annual Income for Sliding Scale/Fee Discounts

Based on Percentage of Federal Poverty Level*

Family Size
100%
150%
175%
200%
1
$0 - $11,670
$11,671 - $17,505
$17,506 - $20,423
$20,424 - $23,340
2
$0 - $15,730
$15,731 - $23,595
$23,596 - $27,528
$27,529 - $31,460
3
$0 - $19,790
$19,791 - $29,685
$29,686 - $34,633
$34,634 - $39,580
4
$0 - $23,850
$23,851 - $35,775
$35,776 - $41,738
$41,739 - $47,700
5
$0 - $27,910
$27,911 - $41,865
$41,866 - $48,843
$48,844 - $55,820
6
$0 - $31,970
$31,971 - $47,955
$47,956 - $55,948
$55,949 - $63,940
7
$0 - $36,030
$36,031 - $54,045
$54,046 - $63,053
$63,054 - $72,060
8
$0 - $40,090
$40,091 - $60,135
$60,136 - $70,158
$70,159 - $80,180

For each additional

person add

$4,060
--
--
--

Sliding Fee

Co-Pay

$20
$25
$30
$35

 

*Based on 2014 HHS Poverty Guidelines: http://aspe.hhs.gov/poverty/14poverty.cfm

* Patient pays at a minimum a $20 nominal fee

All patients are eligible for the sliding-fee-scale discount, without preference to race, creed, sex or color. The only indicators are family income and family size; guidelines are determined by the Federal Poverty Level. Nominal fee of $20 will be required.

LHC reserves the right to amend and/or update this policy at any time.


Both sliding fee scale and discounts will be administered through the Business Office Supervisor and/or the LHC Controller/LHC Director.

Services may be written-off the LHC A/R when approved at the following levels:

 

Sliding Fee Discount
Up to $1,000
Business Office Supervisor
Sliding Fee Discount
> $1,000
LHC Controller
Sliding Fee Discount
> $10,000
LHC Director
 

Any discounts, adjustments, or amendments outside of this policy must be approved by LHC Administration and LHC Board, a subcomponent of MRMC Board of Trustees.

 

 

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