Patients & Visitors

Here is the list of financial policies developed and maintained by OMC's Business Office including the FAP, AGB and Billing Collection Policy.


Billing and Collection Policy

Effective: January 1, 2016
Department: Business Office

Purpose

This policy applies to any charges billed through Osceola Medical Center. Together with the Financial Assistance Policy, the Collection Policy is intended to meet the requirements of applicable federal, state, and local laws, including, without limitation, section 501(r) of the Internal Revenue code of 1986, as amended, and regulations thereunder. This policy establishes the actions that may be taken in the event of nonpayment for medical care provided by Osceola Medical Center, including collection actions and reporting to credit agencies. The guiding principles behind this policy are to treat all patients and Responsible Individual’s equally with dignity and respect and to ensure appropriate billing and collection procedures are uniformly followed and to ensure that reasonable efforts are made to determine whether the Responsible Individual for payment of all or a portion of a patient account is eligible for assistance under the Financial Assistance Policy.

Definition

  • Plain Language Summary means a written statement that notifies an individual that Osceola Medical Center offers financial assistance under the FAP for inpatient and outpatient hospital services and contains the information required to be included in such statement under the FAP.
  • Application Period means the period during which Osceola Medical Center must accept and process an application for financial assistance under the FAP. The Application Period begins on the date the care is provided and ends on the 240th day after the PH provides the first billing statement.
  • Billing Deadline means the date after which Osceola Medical Center may initiate an ECA against a Responsible Individual who has failed to submit an application for financial assistance under the FAP. The Billing Deadline must be specified in a written notice to the Responsible Individual provided at least 30 days prior to such deadline, but no earlier than the last day of the Notification Period.
  • Completion Deadline means the date after which Osceola Medical Center may initiate or resume an ECA against an individual who has submitted an incomplete FAP if that individual has not provided the missing information and/or documentation necessary to complete the application. The Completion Deadline must be specified in a written notice and must be no earlier than the later of (1) 30 days after Osceola Medical Center provides the individual with this notice; or (2) the last day of the Application Period.
  • Extraordinary Collection Action (ECA) means any action against an individual responsible for a bill related to obtaining payment of a Self-Pay Account that requires a legal or judicial process or reporting adverse information about the Responsible Individual to consumer credit reporting agencies/credit bureaus. ECAs do not include transferring of a Self-Pay Account to another party for purposes of collection without the use of any ECAs. FAP-Eligible Individual means a Responsible Individual eligible for financial assistance under the FAP without regard to whether the individual has applied for assistance.
  • Financial Assistance Policy (FAP) means Osceola Medical Center Financial Assistance Program for Uninsured Patients Policy, which includes eligibility criteria, the basis for calculating charges, the method for applying the policy, and the measures to publicize the policy, and sets forth the financial assistance program.
  • Notification Period means the period during which Osceola Medical Center must notify an individual about its FAP in order to have made reasonable efforts to determine whether the individual is FAP-Eligible. The Notification Period begins on the first date care is provided to the individual and ends on the 120th day after PH provides the individual with the first billing statement for the care.
  • PFS means Patient Financial Services, the operating unit of Osceola Medical Center responsible for billing and collecting Self-Pay Accounts.
  • Responsible Individual means the patient and any other individual having financial responsibility for a Self-Pay Account. There may be more than one Responsible Individual.
  • Self-Pay Account means that portion of a patient account that is the individual responsibility of the patient or other Responsible Individual, net of the application of payments made by any available healthcare insurance or other third-party payer (including co-payments, co-insurance and deductibles), and net of any reduction or write off made with respect to such patient account after application of an Assistance Program, as applicable.

Policy

A. Subject to compliance with the provisions of this policy, Osceola Medical Center may take any and all legal actions, including Extraordinary Collection Actions, to obtain payment for medical services provided.

B. Osceola Medical Center will not engage in ECAs, either directly or by any debt collection agency or other party to which the hospital has referred the patient’s debt, before reasonable efforts are made to determine whether a Responsible Individual is eligible for assistance under the FAP.

C. A FAP, or plain language summary and application form for financial assistance will be available on the OMC website, at Registration desks, and upon request.

D. At least three separate statements for collection of a Self-Pay accounts shall be mailed to the last known address of each Responsible Individual prior to the end of the Notification Period; provided, however, that no additional statements need be sent after Responsible Individual submits a complete application for financial assistance under the FAP. At least 60 days shall have elapsed between the first and last of the required three mailings. All patient statements will include:
1. The amount required to be paid by the responsible individual
2. A conspicuous written notice that notifies and informs the Responsible Individual(s) about the availability of Financial Assistance under the hospital FAP including the telephone number of the department and direct website address where copies of documents may be obtained.

Detailed itemization for OMC charges will be provided up request. It is the responsible individual’s obligation to provide a correct mailing address at the time of service or upon moving. If an account does not have a valid address, the determination for “Reasonable Effort” will have been made.

E. At least one of the statements sent during the Notification Period will include written notice that informs the Responsible Party about the ECA”s that may be taken if the Responsible Individual does not apply for financial assistance under the FAP or pay the amount due by the Billing Deadline (i.e., the last day of the Notification Period). Such a statement must be provided to the Responsible Individual at least 30 days before the deadline specified in the statement.

F. Prior to initiation of any ECA’s, an attempt will be made to contact Responsible Individuals with a higher propensity to pay by telephone at the last know telephone number, if any, at least once during the series of mailed statements if the account remains unpaid. During all conversations, the patient or Responsible Individual will be informed about the financial assistance that may be available under the FAP. The criteria below will be used to decide which accounts will receive phone calls:
1. If the patient has insurance, a phone call will be placed after the second statement. This will only occur if the family’s total balance is above $500.00, and no payment or a payment below the guidelines listed on the back of the statement has been received.
2. If the patient does not have insurance, a phone call will be placed after the second statement. This will only occur if the family’s total balance is above $1500.00, and no payment or a payment below the guidelines listed on the back of the statement has been received.
3. Phone calls may be placed outside of these guidelines if need be on a case by case basis.
4. For a listing of the payment guidelines, please see the Financial Assistance Policy.

G. ECAs may be commended as follows:
1. If any Responsible Individuals fail to apply for financial assistance under the FAP by the last day of the Notification Period, and the Responsible Parties have received the 30-day statement described in section III.6 above, then OMC may initiate ECAs.

2. If a Responsible Person has applied for financial assistance under the FAP in the last six (6) months, and the PFS determines definitively that the Responsible Individuals are ineligible for any financial assistance under the FAP (including because the patient was not uninsured), OMC may initiate ECAs.

3. If OMC has determined that a “Reasonable Effort” has been made in the last six (6) months on a Responsible Individual, any new accounts for that Responsible Individual will be assumed that “Reasonable Effort” has already been made and OMC may initiate ECAs.

4. If any Responsible Individual submits an incomplete application for financial assistance under the FAP prior to the Application Deadline, the ECAs may not be initiated until after each of the following steps has been completed:
a. OMC provides the Responsible Individual with a written notice that the addition information or documentation required under the FAP in order to complete the application for financial assistance, which notice will include a copy of the Plain Language Summary.
b. PFS provides the Responsible Individual with at least 30 days’ prior written notice of the ECAs that OMC may initiate against the Responsible Individual if the FAP application is not completed or payment is not made; provided, however, that the deadline for completion or payment may not be set prior to the Notification Deadline.
c. If the Responsible Individual who has submitted the incomplete application completes the application for the financial assistance, and PFS determines definitively that the Responsible Individual is ineligible and financial assistance under the FAP, OMC may initiate EACs.
d. If the Responsible Individual who has submitted the incomplete application fails to complete the application by the Completion Deadline set in the notice provided pursuant to Section III.G.4.b above.
e. If an application, complete or incomplete, for financial assistance under the FAP is submitted by a Responsible Person, at any time prior to the Application Deadline, OMC will suspend ECA’s while such financial assistance application is pending.

H. After the commencement of ECAs is permitted under Section III. 7 above, external collection agencies shall be authorized to report unpaid accounts to credit agencies, and to file litigation, garnishment, obtain judgment liens and execute upon such judgment liens using lawful means of collection; provided, however, that prior approval of PFS shall be required before initial lawsuits may be initiated. OMC may also take any and all legal other actions to obtain payment for medical services provided.

Policy Availability

Contact our Business Office at 715-294-2111 for more information regarding eligibility or the programs that may be available to you, to request a copy of the FAP, Community Care application, or Billing and Collection Policy. Full disclosure of the FAP, Community Care Policy and application, or Billing and Collection Policy may be found at www.MYOMC.org. A paper copy of our FAP, Community Care Policy and application, Billing and Collection Policy can be obtained at our facility located at 2600 65th Ave, Osceola, WI 54020 at the business office, registration areas, emergency department or the Osceola Library located at 102 Chieftain Street, Osceola, WI 54020.


Financial Assistance Policy (Plain Language Summary)

Emergency Care

Osceola Medical Center will provide care for all individuals considered to be in an emergency medical condition, disregarding the patient’s ability to pay.

Payment Plans

If the patient is unable to pay for services received in full (after it has been determined that the balance is patient responsibility) there is the option to begin a payment plan.

Patients interested in a plan should contact one of our financial counselors for terms and conditions:

  • Total Balances of $100 or less must be paid in full with a maximum of 2 payments.
  • Total Balances of $101-$500 must be paid in full with a maximum of 4 payments.
  • Total Balances of $501-$1000 must be paid in full with a maximum of 5 payments.
  • Total Balances of $1001-$3000 must be paid in full with a maximum of 8 payments.
  • Total Balances of $3001-$5000 must be paid in full with a maximum of 10 payments.
  • Total Balances of $5001 and more must be paid in full with a maximum of 10 payments.

Community Care

Community Care was established to assist patients with their healthcare financial needs. Patients who are unable to pay for their healthcare may apply for Community Care assistance. Community Care is available on special hardship basis. Community Care is available to Osceola Medical Center patients after all other resources of payment have been exhausted AND the patient has been denied for medical assistance. All patients receive medical care regardless of their ability to pay. To inquire about Community Care, please ask to speak with a Financial Counselor.

Osceola Medical Center shall review and evaluate each applicant’s situation in order to base a decision on qualifications. Osceola Medical Center will review:

  • Size of family
  • Individual or family income
  • Other sources of payments for services rendered.

Collection Policy Reference

Osceola Medical Center may report to a collection agency in the event of inadequate payment. We hold a separate policy outlining collection procedures; please look to this policy for details.

Resources

For information or assistance call 715-294-2111 or 1-888-565-4662 and ask to speak with a Financial Counselor or Patient Advocate. To meet with someone directly come to Osceola Medical Center, 2600 65th Ave, Osceola WI. A full version of the Financial Assistance Policy or a Community Care Application can be also obtained at the Osceola Public Library, 310 Chieftain Street, Osceola WI 54020 or www.myomc.org.


Financial Assistance Policy (Full Version)

Emergency Care

Osceola Medical Center will provide care for all individuals considered to be in an emergency medical condition, disregarding the patient’s community care eligibility.

Payment Plans

If the patient is unable to pay the bill in full, for services rendered (after it has been determined that the balance is patient responsibility) there is the option to begin a payment plan.

Patients interested in establishing a payment plan should contact one of our financial counselors for terms and conditions. Payment plan lengths are based on the amount the patient owes as outlined in the payment guidelines. Some flexibility is allowed depending on circumstances. Osceola Medical Center does not charge interest on patient accounts.

  • Total Balances of $100 or less must be paid in full with a maximum of 2 payments.
  • Total Balances of $101-$500 must be paid in full with a maximum of 4 payments.
  • Total Balances of $501-$1000 must be paid in full with a maximum of 5 payments.
  • Total Balances of $1001-$3000 must be paid in full with a maximum of 8 payments.
  • Total Balances of $3001-$5000 must be paid in full with a maximum of 10 payments.
  • Total Balances of $5001 and more must be paid in full with a maximum of 10 payments.

Collection Policy Reference

Osceola Medical Center may report to a collection agency in the event of inadequate payment. Osceola Medical Center holds a separate policy outlining collection procedures; please reference this policy for details.

Community Care

Community Care was established to assist patients with their healthcare financial needs. Patients who are unable to pay for their healthcare may apply for Community Care assistance. Community Care is available on a special hardship basis. Community Care is available to Osceola Medical Center patients after all other resources of payment have been exhausted AND the patient has been denied for medical assistance. All patients receive emergency medical care regardless of their ability to pay. If approved, Community Care is valid for one year from the approval date, with a follow-up verification completed after 6 months. It is the patient’s responsibility to notify OMC immediately should there be a change in the determining factors within the approved year period.

Policy of Community Care

Osceola Medical Center shall review and evaluate each applicant’s situation in order to base a decision on qualifications. Osceola Medical Center will review:

  • Size of family
  • Individual or family income
  • Other sources of payments for services rendered.

Once a decision is reached Osceola Medical Center will notify the patient of the decision. If approved the patients discount will not exceed one year’s time without the completion of an additional application and/or a full financial situation review.

Criteria of Eligibility

  • Application: To be considered for community care, patients must cooperate by returning a completed application, and all required documentation. Failure to do so may result in a denial and accounts advancing to collections. In specific cases an application may be approved with the use of oral information or presumptively.
  • Size of Family: The size of a family will be determined by the individual’s most recent tax return. The status of “dependants” will be the governing rule, regardless of the site of residence of individuals.
  • Individual or Family Income: Information must be supplied by the patient or someone acting on the patients behalf. This information will be verified to the extent practical, given the amounts involved and the significance of the data given to the overall determination. Osceola Medical Center reserves the right to request a current tax return, recent pay stubs showing year to date earnings, and bank statements. Other documentation may be requested on a case by case basis if it is needed to verify income.

2019 Poverty Guidelines

Persons in Family 100% 150% 200% 220% 240% 260% 280% 300% 301%
1 $12,490 $18,735 $24,980 $27,478 $29,976 $32,474 $34,972 $37,470 $37,595
2 $16,910 $25,365 $33,820 $37,202 $40,584 $43,966 $47,348 $50,730 $50,899
3 $21,330 $31,995 $42,660 $46,926 $51,192 $55,458 $59,724 $63,990 $64,203
4 $25,750 $38,625 $51,500 $56,650 $61,800 $66,950 $72,100 $77,250 $77,508
5 $30,170 $45,255 $60,340 $66,374 $72,408 $78,442 $84,476 $90,510 $90,812
6 $34,590 $51,885 $69,180 $76,098 $83,016 $89,934 $96,852 $103,770 $104,116
7 $39,010 $58,515 $78,020 $85,822 $93,624 $101,426 $109,228 $117,030 $117,420
8 $43,430 $65,145 $86,860 $95,546 $104,232 $112,918 $121,604 $130,290 $130,724
Community Care
Percentage
100% 100% 100% 95% 90% 85% 80% 75% 70%

*Families/Households with more than 8 persons, add $4,420.00 for each additional person.

Other Sources of Payment: Community Care is the last resort of payment for patients in need of care. It is a requirement that every other financial resource be applied for before Community Care is approved.

Definition of Eligible Services

Community Care will only assist with medically necessary services. Items excluded include, but are not limited to elective services, prescription medications, and Chemotherapy. Osceola Medical Center will determine if a service is medically necessary.

  • Examples of excluded services are, but not limited to, the following: IUD placement, colposcopy, nail ablation, lesion/wart removal, Chemotherapy, and endometrial aspirate.
  • Surgery services and diagnostic imaging such as MRI’s and CT’s will need to be pre-approved before scheduling.
  • If you are unsure if a procedure or services will qualify for Community Care, please call the Business Office for verification in advance.

Appeals

The initial determination of eligibility for Community Care shall be the responsibility of the Financial Counselors. All patients who do not qualify for Community Care will be notified of the denial with an option to have this determination reviewed. If the patient requests this review, the Business Office Manager will arrange for an appeal panel. The review and decision will be based upon Osceola Medical Center policy and judgment will be equitably and consistently applied.

Exceptions

In a case by case review Osceola Medical Center holds the right to make exceptions to the guidelines above (such as but not limited to presumptive granting) when it is found to be in the best interest of the patient.

Participating Providers in Available Programs

Warren Abell, Jr., DO; Jennifer Belisle, MD; Felix Blanco, MD; Natalia Cropper, FNP; Erika Helgerson, DO; Brad Johnson, MD; Nicole Johnson, PA-C; David Lang, MD; Bridget McGill, DO; René Milner, MD; Kevin Nepsund, MD; Erik Severson, MD; Nicole Smith, MD; Coby Somsen, CNP; and Amanda Tembreull, MD.

*Financial assistance for specialist and providers other than those listed will be based on a case by case basis.

Resources

For information or assistance call 715-294-2111 or 1-888-565-4662 and ask to speak with a Financial Counselor or Patient Advocate. To meet with someone directly come to Osceola Medical Center, 2600 65th Ave, Osceola WI. A full version of the Financial Assistance Policy or a Community Care Application can be also obtained at the Osceola Public Library, 310 Chieftain Street, Osceola WI 54020 or www.myomc.org.

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