b. Referred guarantors will be provided a FAP letter and application.( Appendix A & B) c. Multiple accounts may be submitted for review on a single FAP application. d. Assets exempt from financial consideration include the residence where a guarantor and / or guarantor’ s family resides, automobiles needed to transport all working parties to and from work, any prepaid burial contract or burial plot, any life insurance policy with a value of $ 10,000 or less, bank accounts with less than two months of income, and retirement accounts. e. The application and the financial documentation requested in the FAP letter to the guarantor must be returned Renown Financial Assistance for an application to be considered complete. f. If a guarantor needs assistance in completing the FAP application, they can contact a Financial Assistance Specialist at 775-982-5747 or toll free at 855-951-6871 or at the Business Office at 775-982-4130 or toll free at 866-691-0284 or on-line at Renown. org. g. Applications not completed within 60 calendar days of issuance will be denied. Extensions can be approved by the Supervisor.
4. Eligibility Criteria
a. Renown Health hospital-based services, and the related professional-based services associated with the hospital-based visit provided by a Renown Health provider, are eligible for the FAP. i.
Physicians and surgeons furnishing services at the Hospital including, but not limited to, anesthesiologists, emergency physicians, pathologists and radiologists may be independent contractors who are permitted to use the Hospital’ s facilities for the care and treatment of their patients. Some physicians and surgeons are not agents of Renown Health, and a guarantor may receive a separate bill from these physicians for their services. Services rendered by independent contractors, or agents not of Renown Health, are not subject to Renown Health’ s financial assistance program. 1. A list of non-participating providers credentialed at Renown Health facilities is available at https:// www. renown. org / patients-and-visitors / billing / financial-assistance. b. Open accounts, as well as accounts in Bad Debt or collections for less than 90 days are eligible. Exceptions may be requested and require approval from the VP of Revenue Cycle or above. c. The FAP does not apply to charges deemed not medically necessary. d. The FAP may not be used for cosmetic or bariatric procedures, fertilizations, same day, or package price procedures. e. All screenings will be based on the guarantor’ s financial status at the time of application. f. Guarantors must meet the following criteria: i. Guarantors are required to apply for government assistance / insurance.
1. Guarantors who have an income that disqualifies them for government assistance / Insurance are not required to apply for government assistance / Insurance.
2. If a patient is non-cooperative for government assistance, the patient may be denied Financial Assistance. ii. Applicants will be assigned an FPL using the national FPG matrix documented in current use at the time of application. 1. Guarantors with a household FPL ≤400 % will be considered for the FAP program.
g. Special Circumstances: i. Guarantors who have become totally disabled due to medical condition and will no longer have their past level of income used to determine FPL. ii. Catastrophic: Catastrophic costs occur when a patient’ s medical expenses for an episode of care exceeds 25 % of their annual pre-tax income OR if medical expenses for them or their immediate family members incurred at Renown or paid to Renown