Financial Assistance

This policy applies to all medically necessary services provided by Kane County Hospital (KCH), including services provided at KCH facilities by employed physicians. It establishes KCH’s guidelines for offering financial assistance (charity care) to patients who are uninsured, underinsured, indigent, or facing financial hardship, ensuring compliance with Utah State and Federal non-profit hospital requirements.

To ensure that emergency and medically necessary hospital services are available to all members of the community regardless of their ability to pay, in alignment with KCH’s mission as a non-profit community hospital and in compliance with Utah property tax exemption requirements and the Affordable Care Act (ACA).

• Amounts Generally Billed (AGB): The maximum amount a hospital may charge an individual eligible for financial assistance for medically necessary care. It is calculated based on the average payment received by the hospital for emergency or medically necessary care by commercial insurers and Medicare.
• Charity Care: Healthcare services provided free of charge or at a reduced rate to patients who meet the eligibility criteria defined in this policy and are unable to pay for care due to financial hardship.
• Extraordinary Collection Actions (ECA): Actions taken by a hospital or its agent against an individual to obtain payment for care, such as referring a debt to a collection agency, selling the debt, initiating litigation, seeking garnishments, using State resources to recover debt, or placing a lien on an individual’s property.
• Federal Poverty Level (FPL): Income thresholds published annually by the U.S. Department of Health and Human Services (HHS), used as the primary benchmark for determining eligibility for financial assistance programs.
• Financial Assistance Policy (FAP): The full, detailed document outlining eligibility criteria, the application process, and the calculation of discounts provided by KCH.
• Medically Necessary Services: Health care services that a physician determines are needed to diagnose or treat an illness, injury, condition, disease, or its symptoms in a manner consistent with generally accepted standards of medical practice.
• Uninsured/Self-Pay: A patient who does not have health insurance coverage or other third-party coverage liable for the bill.

Kane County Hospital maintains an “open access” policy and a board-approved Financial Assistance Policy (FAP) to provide discounts for eligible patients. The criteria for eligibility are uniformly based on family income relative to the Federal Poverty Level (FPL). KCH will not require a minimum payment amount from a patient to be considered for or receive charity care.

Financial assistance eligibility is determined using a sliding scale based on the patient’s gross family income and family size compared to the current U.S. Department of Health and Human Services (HHS) Federal Poverty Level guidelines.

• Full Financial Assistance (100% discount): Available to patients with family incomes below 125% of the FPL.
• Partial Financial Assistance (Sliding Scale Discount): Available to patients with family incomes above 125% but below 300% of the FPL; FPL above 300% are subject to Catastrophic Loss or special circumstances. The specific discount percentage will be determined by the hospital’s established sliding scale formula.
• Amounts Generally Billed (AGB) Limit: Patients qualifying for partial assistance will not be charged more than the Amounts Generally Billed (AGB) to individuals who have insurance coverage.

• Application Period: Patients may apply for financial assistance up to 240 days after the date the first post-discharge bill is issued. KCH will not engage in extraordinary collection actions (ECAs) against the patient during the application processing period.
• Required Documentation: Eligibility is determined by reviewing the patient’s application and necessary supporting documentation (e.g., pay stubs, tax returns, unemployment records, bank account statements).
• Presumptive Eligibility: KCH reserves the right to determine presumptive eligibility for financial assistance based on existing third-party information (e.g., Medicaid eligibility criteria, homelessness status) without a formal application if sufficient information is available to confirm eligibility criteria are met.

KCH is committed to making reasonable efforts to inform the community about the availability of financial assistance.

• Availability of Policy: The plain-language summary of this policy, the full FAP document, and the application form will be made publicly available on the KCH website and in paper form, free of charge, in all registration and admission areas.
• Signage: Clear and prominent signage regarding the availability of financial assistance will be displayed in patient access points, including the emergency department, clinics, and admission centers.
• Billing Statements: All patient billing statements will include a conspicuous, plain-language notice informing patients how to obtain the FAP and application form or contact KCH business office staff for assistance.

This policy is designed to comply with relevant Utah State and U.S. Federal laws governing hospital billing, charity care, and non-profit requirements:

The total discounted amount is based on the Financial Assistance and Charity Application (FPL). The application applies a reduction to the Federal Poverty Guidelines adjustment offered by Kane County Hospital.

The following sections relate to KCH’s separate Sliding Fee Scale, Uninsured Discount, and Charity Care, together known as financial assistance policies, and are distinct from the payroll deduction policy.

The following services are excluded from coverage under Kane County Hospital’s (KCH) Sliding Fee Scale and Uninsured Discount policies. KCH reserves the right to also exclude other procedures that are deemed not medically urgent.

• Fecal Occult Blood Testing
• Negative Press wound V.A.C.
• Obesity treatments, surgical and pharmaceuticals
• Occupational therapy
• Over-the-counter medications and supplies
• Physical therapy
• Routine physical exams
• Sexual function disorders
• Screening – colonoscopy
• Screening – PSA
• Screening – Mammograms
• Skin disorders without malignant potential
• Speech therapy
• Sterilization procedures (except post-partum tubal ligation)

The following services require approval from administration to be covered under Kane County Hospital’s (KCH) Charity Care and Uninsured Patient Discount policies.

• Cancer Therapy
• Cataract Surgery
• Multidisciplinary rehabilitation services, inpatient
• MRI
• Post-partum tubal ligation
• Skilled nursing facilities

This is for informational purposes only. For medical advice or diagnosis, consult a professional.
Excluded services can change without notice.