FAQs for PeaceHealth Financial Assistance

What is Financial Assistance?

Financial Assistance is the PeaceHealth program that provides emergent, medically necessary and some preventive pre-authorized services at a reduced cost or without charge when payment cannot be obtained through all other available financial resources. It is limited to patients at PeaceHealth facilities.
 
This program allows us to manage our financial health with our mission of providing care to all in need. It ensures that patients receive fair and equal financial treatment across PeaceHealth.
 

Why is it called Financial Assistance instead of charity care?

In the spirit of our core value, Respecting Individual Human Dignity and Worth, PeaceHealth avoids using the term charity, which can carry negative connotations.
 

What types of services are covered?

Financial Assistance is granted for emergent and/or medically necessary services.
 

Medically necessary services include care that, in accordance with clinically accepted parameters, is reasonably calculated to:

  • Prevent the onset or worsening of an illness, condition, or disability;
  • Establish a diagnosis;
  • Provide palliative, curative or restorative treatment for physical, behavioral, and/or mental health conditions; and/or
  • Assist the individual to achieve or maintain functional capacity in performing daily activities, taking into account both the functional capacity of the individual and those functional capacities that are appropriate for individuals of the same age.
  • Each service is performed in accordance with national standards of medical practice generally accepted at the time the services are rendered, and must be sufficient in amount, duration, and scope to reasonably achieve its purpose.  Course of treatment may include observation only, or when appropriate, no treatment at all.
  • Please note that for any non-urgent future services, a review for medical necessity is required in order to be covered under the Financial Assistance program. Your referring physician will need to submit a request for clinical review to our Referral and Eligibility department prior to any scheduled service.

Does PeaceHealth Financial Assistance apply to non-PeaceHealth provider fees and services?

PeaceHealth Financial Assistance is granted only for financial obligations related to PeaceHealth care. It is not available for the services of physicians or other health care, please contact your provider to see if they offer financial assistance.
 

Where is Financial Assistance available?

Financial Assistance is available in the service area (county or local area) in which a PeaceHealth facility is located.
 

What if the patient lives outside of a PeaceHealth county/service area?

Patients who live outside PeaceHealth’s county/service area are eligible for Financial Assistance when they need emergent care.
 
In some cases, exceptions may also be made if medically necessary services are not available in your local area but are able to be provided by PeaceHealth.
 

What is the first step in determining eligibility?

Anyone seeking Financial Assistance will be screened using PeaceHealth system standards, as listed in the Financial Assistance Procedure. Patients who meet criteria complete an application, which must receive formal approval.
 

Who can initiate this process?

Anyone—a patient, physician, family member, community and/or religious group, or hospital personnel—can initiate this process.
 

When can a patient apply?

A patient may apply at any time—before, during or after treatment.
 

How does a patient apply?

Instructions and the application are available on the Financial Assistance page and also may be obtained from a Customer Service Representative by calling 877-202-3597.
 

Is the process confidential?

All information is kept confidential.
 

Is the amount of care a determining factor?

No, the process is the same for both eligibility and approval, regardless of the amount of the patient’s balance.
 

How is payment addressed while this process is underway?

PeaceHealth will not initiate collection efforts or requests for deposits while an application is being processed.
 

How is eligibility determined?

Each situation will be reviewed independently. These guidelines help determine eligibility:
  • annual household income
  • number of people in the household
  • securable assets (excluding primary residence, family’s primary mode of transportation and retirement accounts)
  • credit history
  • existing debt
  • other indicators of ability to pay
Financial Assistance is granted to all applicants whose Adjusted Gross Income (AGI) falls at or below 200 percent of the current Federal Poverty Levels. Assets are not considered for these applicants.
 
Financial Assistance will be awarded to applicants whose Adjusted Gross Income is between 201 and 400 percent of the current Federal Poverty Level (FPL). Assets and reasonable living expenses may also be considered when determining eligibility for Financial Assistance for these applicants. 
 
 
Federal Poverty Percentages
Financial Assistance Allowance
0 to 200% 100%
201 to 250% 85%
251 to 400% 65%
 

When will a patient be notified of the decision?

Written notice of assistance determinations will be mailed within 14 calendar days from receipt of the completed application. The notification includes the level of reduction and payment arrangements consistent with ability to pay. Denials include the reason for denial and instructions for seeking an appeal or a reconsideration.  
 

What types of circumstances would not receive approval?

Financial assistance is not granted for procedures that are not medically necessary or when insurance or government programs are available to the patient.   
 

Is there a way to appeal an eligibility decision?

Yes, the person responsible for the financial obligation may appeal by submitting additional information to PeaceHealth Revenue Cycle within 30 days of the denial notice.
 
The Vice-President of the Revenue Cycle or designee has the authority to make the final determination for all appeals.
 

Are handouts available?

Brochures are available at all PeaceHealth facilities in areas such as registration, check-in, exam rooms and cashier stations, and from Financial Counseling Services or Customer Service.  More information can be found on the Plain Language Summary.
 

Who can a patient talk to?

Customer Service Representatives at 877-202-3597 are happy to help.