HFA Policy
PLAIN LANGUAGE SUMMARY OF HEALTHCARE FINANCIAL ASSISTANCE POLICY
Overview
Coastal Virginia ASC is committed to providing financial assistance to its patients. This is a summary of the Coastal Virginia ASC Healthcare Financial Assistance (HFA) Policy.
Availability of Financial Assistance
Eligibility for financial assistance is determined by the ability of the patient or his/her guarantor to pay after all available resources have been utilized and all available assistance programs have been assessed. Financial assistance is available for medically necessary care provided by Coastal Virginia ASC to uninsured and underinsured patients served by Coastal Virginia ASC and whose family income does not exceed two times the Federal Poverty Guidelines (FPG).
Eligibility Requirements
Financial assistance is generally determined by a sliding scale of total household income based on the FPG. Individuals eligible for financial assistance under our Policy with an income level at 200% FPG or below receive free care. Only covered services provided in the facility by the facility itself are considered eligible patient care. Each physician bills separately for his/her services and follows his/her own financial assistance and billing and collection procedures.
No person eligible for financial assistance under the HFA policy will be charged more for emergency or other medically necessary care than amounts generally billed to individuals who have insurance covering such care. If an individual has sufficient insurance coverage or assets available to pay for care, he/she may be deemed ineligible for financial assistance. Please refer to the full HFA Policy for a complete explanation.
About the Application Process
The process for applying for financial assistance under our HFA Policy includes these steps:
- Complete the HFA Application Form and include required supporting documents.
- We look at your income and family size to determine the level of assistance available to you based on FPG outlined above.
- Financial Assistance is not available for patients who fail to reasonably comply with applicable payor requirements,
including, but not limited to, obtaining authorizations, referrals, or other requirements for claim adjudication, or when a Third-
Party Liability Claim is available to the patient. - Financial Assistance will be denied if a patient or patient’s responsible party/guarantor provides false information regarding
his/her income, household size, assets, liabilities, expenses, or other resources available that might indicate a financial
means to pay for Covered Services.
- We will contact you to tell you whether you are eligible for financial assistance under our HFA Policy.
- We can help you arrange a payment plan for any remaining charges or bills that are not covered under our HFA Policy.
- A payment plan will consider your financial situation to set payments that you can manage.
Where to Obtain Information
You may obtain a copy of our HFA Policy and the HFA Application Form, as well as information about the financial assistance application process: (i) by visiting our website at www.coastalvirginiasurgerycenter.com, (ii) by contacting the Center’s Administrator/Compliance Officer at 757-782-4886, or (iii) by mailing a request Coastal Virginia ASC, Attn: Administrator/Compliance Officer, 580 City Ctr Blvd – Third Floor, Newport News, VA 23606, or (iv) by contacting our financial counselors in person at Coastal Virginia ASC.
We accommodate all significant populations served by Coastal Virginia ASC that have limited proficiency in English by translating copies of our HFA Policy, Application Form, and this Summary in the primary languages spoken by those populations. We may also elect to furnish translation aids, translation guides, or provide assistance through use of qualified bilingual interpreters.