Patient Notice of Financial Assistance
Weirton Medical Center (WMC) is a tax-exempt charitable organization within the meaning of section 501 (c) (3) of the Internal Revenue Code and under West Virginia law. It is the mission of WMC to provide quality care to all in need, 24 hours a day, 7 days a week, 365 days a year.
In fulfilling its charitable mission and commitment to the community, WMC offers a financial assistance program for eligible patients. If you do not have health insurance or have concerns that you may not be able to pay part or all of your bill, we may be able to help.
It is the policy of WMC to provide financial assistance to uninsured patients who either demonstrate financial need or are deemed presumptively eligible for assistance based on established criteria.
A patient eligible for Financial assistance may not be charged more that amounts generally billed for emergency or other medically necessary care. In order to ensure patients are not charged more than conventional insurance, the average amount paid by other insurers (look-back method) will be used for the payment requirement for the uninsured (self-pay patients).
For your convenience, a WMC Financial Counselor will evaluate your financial needs and a determination will be made based on established criteria. As part of the program, you may be required to apply for Medical Assistance.
Since Federal and State laws require all hospitals to seek payment for care provided, we may ultimately need to turn unpaid bills over to a collection agency, which could affect your credit status. Therefore, it is important that you let us know if there may be a problem paying your bill.
For more information
Contact our Financial Counselors
(304)797-6042, choose option 3
Monday – Friday: 8:30 AM - 4 PM
Visit our Financial Counselors
Located in the main hospital lobby. Please check in at the Information Desk.
The application is available below, or it can be mailed by contacting the financial counselors.
We will treat your questions and any information provided with confidentiality and courtesy.
Financial Assistance Policy
I. BACKGROUND: Weirton Medical Center (WMC) is a tax-exempt charitable organization within the meaning of section 501(c)(3) of the Internal Revenue Code and a charitable organization under West Virginia law. This financial assistance policy recognizes that WMC provides services to a diverse population of patients. Some patients do not qualify for Medicaid or other forms of public assistance, in spite of having little, if any, income. Other patients may have unexpected and/or extraordinarily high medical bills without sufficient income or liquid assets to satisfy their obligations. Accordingly, depending on individual circumstances, this financial assistance program provides eligible patients with options for resolving their financial obligations to WMC. These options include the following:
- Assisting patients with applying and obtaining eligibility for West Virginia, Ohio and Pennsylvania Medicaid
- Eligibility for financial assistance based on verified need
- Graduated levels of financial assistance, up to and including 100% forgiveness
- Discounts to uninsured patients
- Interest-free installment payment plans
II. POLICY: WMC’s policy is to provide emergency and medically necessary care to patients without regard to their ability to pay. In fulfilling its charitable mission and commitment to the community it serves, WMC offers a financial assistance program for eligible patients. The principal beneficiaries of this policy are intended to be uninsured patients who are not eligible for their State of residence Medical Assistance Program and/or other private or public funding sources and whose annual household income does not exceed 300% of the Federal Poverty Income Guidelines (FPG) as published from time to time by the U.S. Department of Health and Human Services, and in exceptional circumstances, may be available for patients with annual household income exceeding 300% of the FPG. Please see Attachment A.
It is the policy of WMC to provide, within budgetary limits, financial assistance to uninsured patients who either demonstrate financial need, or are deemed presumptively eligible for assistance based on established criteria. In addition, insured patients with copayments, deductibles, coinsurance and/or non-covered charges remaining after insurance payments have been received, may be eligible for financial assistance based on demonstrated financial need or presumptive eligibility. Please see Attachment B.
It is the policy of WMC to provide, within budgetary limits, financial assistance to uninsured Financial Assistance is not considered to be a substitute for personal responsibility. Patients are expected to cooperate with WMC’s procedures for obtaining financial assistance or other forms of payment, including any and all sources of coverage available through expanded Medicaid eligibility and/or Commercial Insurance Exchanges available within the patient’s State of residence or from the Federal Exchange, provided for in the Affordable Care Act. Patients are also expected to contribute to the cost of their care based on individual ability to pay.
A determination of financial assistance for a given patient will be revalidated every six (6) months. WMC reserves the right to amend this policy at any time.
III. SCOPE: This policy applies to eligible healthcare services (described below) provided by WMC. Although WMC, with appropriate authorization, is willing to notify physicians who participated in the patients’ care, it does not have the authority to waive or discount any
charges from physicians who are not employed by WMC. Such notification does not obligate non-employed physicians to reduce or forgive patient balances for their professional services.
Any WMC patient, regardless of residency status and United States citizens, may be eligible for financial assistance. The granting of financial assistance shall be based on an individualized determination of financial need, and shall not take into account age, gender, race, social or immigrant status, sexual orientation or religious affiliation.
Financial Assistance will be considered only after all payment options have been exhausted by the patient. Those options include, but are not limited to, Medicaid within their State of residency and State and/or Federal Commercial Insurance Exchanges as applicable.
EMERGENCY CARE: Care or treatment for a medical screening examination and, when applicable, care for an emergency medical condition as defined by EMTALA.
FINANCIAL ASSISTANCE (aka Charity Care): healthcare services that have or will be provided, but are not expected to result in cash inflows. Financial assistance results from WMC’s policy to provide healthcare services free or at a discount to individuals who meet established criteria.
HOUSEHOLD: A household shall mean the patient, patient’s spouse and all of the patient’s children, natural or adoptive, under the age of eighteen who live at home. If the guarantor claims someone as a dependent on his/her income tax return, this person may be considered a dependent for purposes of financial assistance determination.
HOUSEHOLD INCOME: Wages and salaries before deductions, net income from self-employment, social security, retirement income, unemployment compensation, royalty income, workers’ compensation, disability compensation, pensions, strike benefits, public assistance, alimony, child support, dividends, interest, rental income, gambling and lottery winnings.
MEDICALLY NECESSARY SERVICE(S): A service that is reasonably expected to prevent, diagnose, prevent the worsening of, alleviate, correct or cure conditions that endanger life, cause suffering or pain, cause physical deformity or malfunction, threaten to cause or aggravate a handicap, or result in illness or infirmity. Medically necessary services shall include inpatient and outpatient services mandated under Title XIX of the Federal Social Security Act. Medically necessary services shall not include: (a) non-medical services, such as social, educational, and vocational services; (b) cosmetic surgery; canceled or missed appointments; (c) research or the provision of experimental or unproven procedures; (d) the provision of whole blood; provided, however, that administrative and processing costs associated with the provision of blood and its derivatives shall be payable; and (e) private room differential. The following are excluded: Guest Meals. Exceptions may be made subject to approval by the CEO or CFO.
V. PROCEDURE GUIDELINES:
A. Services eligible under this policy
For purposes of this policy, the following healthcare services are eligible for financial assistance consideration:
- Emergency medical services provided in an emergency room setting.
- Services for a condition which, if not promptly treated, would lead to an adverse change in the health status of the patient.
- Non-elective services provided in response to life-threatening circumstances in a non-emergency room setting.
- Medically necessary services, evaluated on a case-by-case basis at WMC’s discretion.
NOTE: Pursuant to the Emergency Medical Treatment and Active Labor Act (EMTALA), patients presenting with an emergency medical condition who have either not had a medical screening examination, or have had such screening and remain unstable, will not have their care delayed pending initiation of any financial assistance process described herein.
B. Eligibility Criteria for Financial Assistance
- In general, patients whose annual household income does not exceed 300% of the FPG, who meet the other criteria set forth in this policy, and who apply for assistance as required in section C below are eligible for financial assistance under this policy.
- If a patient’s annual household income exceeds 300% of the FPG, and the patient provides information to support extraordinary medical circumstances (e.g. terminal illness, exceptional medical bills and/or medications, etc.) he/she will be considered for assistance if 100% of the patient’s liability exceeds 25% of the annual household income. All requests for exceptional circumstance review must be approved by the Director, Patient Financial Services.
- If it is determined that a patient has existing financial assistance at another hospital, they will be referred back to that hospital.
C. Method of Applying for Financial Assistance
- To be eligible for financial assistance under this policy, individuals must apply for financial assistance and cooperate with WMC in determining whether or not he/she is eligible for assistance under this policy.
- The financial counselor will discuss with patients their individual financial circumstances and obtain from them a completed and signed Financial Assistance application, along with copies of proof of income. Proof of income includes, but is not limited to, their most recent federal tax return, W2s, pay stubs, Social Security award letter, unemployment letter, bank statements. Patients will also be required to provide photo identification, proof of application for Medicaid and/or Commercial Insurance through the Insurance Exchange within their State of residence.
- The financial counselor will determine the level of assistance based on proof of income documents provided.
- Before WMC initiates extraordinary collection activities, the Financial Assistance Application, along with supporting documentation as required, must be completed and received by WMC within 120 days from the date the patient was initially billed. If and when WMC exercises its right to pursue extraordinary collection activities, the patient has an additional 120 day period from the date such activity was initiated in which to submit a Financial Assistance Application.
D. Basis for Calculating Amounts Charged to Patients
Patients eligible for financial assistance under this policy will receive assistance according to the following sliding scale:
|Annual Household Income||Percent of Discount|
|201% to 300%||
A patient eligible for Financial assistance may not be charged more that amounts generally billed for emergency or other medically necessary care. In order to ensure patients aren’t charged more than conventional insurance, the following formula (look-back method--sum paid by private insurers and Medicare past 12 months) will be used for patients that are not covered by insurance (self-pay):
60% DISCOUNT on Total Charges for Inpatient accounts
60% DISCOUNT on Total Charges for Outpatient accounts
Provider List – Please see Attachment C
Transparent Pricing Policy
Every inpatient admission to a hospital is assigned an MS-DRG subsequent to discharge that is based on a number of factors related to that stay, such as diagnosis of the illness or reason for admission, all procedures performed during the inpatient stay and any complications to the patient’s condition/illness that may have occurred during the stay. The Centers for Medicare and Medicaid Services (CMS) requires that all hospitals are to publish the average total charges incurred at their hospital for each of these Medicare Severity Diagnosis-Related Groups (MS-DRG).
The average charges listed for these MS-DRGs at WMC are only an estimate. The total charges for any MS-DRG are affected by many varied factors which are specific to each patient admission. Any MS-DRG’s not listed on the attached file were a result of WMC having no patients assigned to that category in the past year. Also, in compliance with CMS regulations to promote price transparency, we have also provided the required list of charges in a format compliant with CMS standards. Please keep in mind, individual charges are in most cases not reflective in any way of the cost for medical care paid by individual patients.
To be more helpful, WMC makes available to any requesting patient a care cost estimator service designed to help you better understand your payment responsibility for our most common procedures and tests by calling (304)797-6115, Monday – Friday from 8:00 AM to 4:00 PM. Please have the following when you call for any payment estimate.
- Your insurance information
- The name of the procedure about which you are inquiring
It is important to remember that the actual charges due to the hospital for any inpatient admission or price for any individual item charge are determined most times by an individual’s insurance plan based on the rates the insurer has contractually agreed to pay the hospital for any medical care. The type of insurance coverage any patient has will ultimately govern any costs incurred for hospital care at WMC.