5. MAPS

Charitable Assistance

Help for eligible patients who need assistance with hospital expenses.

What is charitable assistance?
Charitable assistance is help for patients who may encounter difficulty paying hospital medical expenses. Depending on a patient’s financial situation, a hospital bill may be partially or totally forgiven.

Who is Eligible?
Patients may be eligible if they:

1. do not have adequate financial resources to pay for care
2. are not covered under any insurance that could provide medical benefits
3. are not eligible for government assistance or other assistance programs
   (except when coverage was denied due to the failure of a patient to cooperate in
    the application/approval process).

How to Apply:

1. Seek help from our Patient Financial Services Representative.
    Call (208) 630-2212, (208) 634-2221, or toll free (888) 236-4643
    Monday - Friday 8 a.m. - 5 p.m.

2. Fill out the enclosed form and return in person or mail to:

    Patient Financial Services Office
    St. Luke's McCall
    1000 State Street
    McCall, ID 83638
    or FAX, (208) 634-7112

Eligibility Determination:
1. In order to receive financial assistance, the patient or responsible party must
    complete the Charitable Assistance Assessment form.

2. Copies of supporting documentation, such as current payroll stubs, tax return(s),
    current bank statements, credit reports, and any form denying insurance coverage
    must be submitted with the application. The patient will have 14 calendar days from
    receiving the application to return the form and supporting documents. All
    information pertaining to the application will be kept confidential.

3. Eligibility for charitable assistance will be based on the income of all adult household
    members and the assets and expenses of the household. The financial resources
    are compared against the US Government’s Federal Poverty levels. In the event
    that a patient or responsible party has significant assets, the hospital may secure
    its interest in those assets. For the patient’s protection, the patient’s primary     residence, adequate transportation and reserves to cover normal living expenses
    will not be encumbered for repayment of the hospital bill(s).

4. If a portion of a bill qualifies for charitable assistance, the remaining amount will
    be due from the patient and will be processed through the normal billing processes.

5. An approval for charitable assistance does not automatically carry over to all
    services or future visits. A patient will need to reapply.

6. Unusual circumstances allow special consideration. Such situations may include:
    homeless patients, deceased patient with an insufficient estate value to pay the
    bill, or overwhelming medical bills. Also, due to unexpected hardships, such as
    losing a job, individuals who are actively paying on accounts may apply for
    charitable assistance to help with the remaining amount of their bill. All situations
    will be evaluated on a case-by-case basis.

Patient Financial Services Office
(208) 630-2212 or
toll free (888) 236-4643
Monday - Friday, 8:00 a.m. to 5:00 p.m.

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