FINANCIAL ASSISTANCE POLICY (FAP) and plain language summary

Ridgeview Psychiatric Hospital and Center is committed to providing charity care to persons who have behavioral healthcare needs and are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay for medically necessary care based on their individual financial situation. Ridgeview strives to ensure that the financial capacity of people who need behavioral healthcare services does not prevent them from seeking or receiving care.

 Accordingly, Ridgeview’s FAP includes the following:

• Eligibility criteria for financial assistance -- free and discounted care;
• Basis for calculating amounts charged to patients eligible for financial assistance;
• Method by which patients may apply for financial assistance;
• Process of managing patient account balances.

SERVICES ELIGIBLE UNDER THIS POLICY

For purposes of this policy, "financial assistance" refers to services provided by Ridgeview without charge or at a discount to qualifying patients. The following services are eligible for financial assistance:

• Emergency services provided by Ridgeview’s Mobil Crisis Team;
• Physician services- provided on an emergent or non-emergent basis;
• Therapy services- including individual, group and family therapy; and
• Any other services provided will be evaluated on a case-by-case basis at Ridgeview’s discretion.

ELIGIBILITY FOR FINANCIAL ASSISTANCE

Eligibility for financial assistance will be considered for those individuals who are uninsured, underinsured, or ineligible for any government health care benefit program. The granting of financial assistance will be based on income and will also take into consideration other relevant information such as household size and excessive medical expenses. The granting of charity shall not take into account age, gender, race, social or immigrant status, sexual orientation, or religious affiliation.

Patients whose income exceeds the eligibility criteria may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances, such as catastrophic illness or medical indigence, at the discretion of Ridgeview.

CALCULATION of FINANCIAL ASSISTANCE

Ridgeview’s FAP utilizes Sliding Fee Scale based on patient’s income level and number of persons in the family unit.  It is based on National Health Service Corps (NHSC) sliding fee discount program.  To qualify for financial assistance, the patient must have annual income below 200% of the current poverty income guidelines as set forth by the US Department of Health and Human Services as shown below.  Patients eligible under the Financial Assistance Program shall not be charged more than the amounts generally billed (AGB) for emergency or other medically necessary care.  Ridgeview uses a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period.

For any questions on the calculation of financial assistance, please contact our Client Services Team at (865) 482-1076 Monday to Friday between the hours of 8am and 5 pm Easter Standard Time or by email to contact@ridgeview.com.

2024 HHS (United States Department of Health & Human Resources)

Persons in Family Unit	Annual Household Poverty Income Guideline	200% of Poverty Income Guideline
1	$15,060	$30,120
2	$20,440	$40,880
3	$25,020	$51,640
4	$31,200	$62,400
5	$36,580	$73,160
6	$41,960	$83,920
7	$47,340	$94,680
8	$52,720	$105,440
9	$58,100	$116,200
10	$63,480	$126,960
For each add ’l 1 person, add	$5,380

Income shall include, but is not limited to, adjusted gross income plus non-taxable retirement income (i.e., Social Security), child support, unemployment compensation, and disability benefits. The value of food stamps will be excluded from income consideration.

APPLYING FOR FINANCIAL ASSISTANCE

Patient’s insurance coverage and eligibility for any other funding sources are determined at the time of patient registration.

Referral of patients for charity may be made by any member of the Ridgeview staff or medical staff.  A request for charity may also be made by the patient or a family member, close friend, or associate of the patient, subject to applicable privacy laws.

Every effort will be made to ensure that patients who are unable to pay are provided information regarding the financial assistance that is available.  All individuals seeking services from Ridgeview will be evaluated for eligibility for financial assistance at the time of registration.  In addition, an individual may request to be reevaluated for financial assistance at any time.  Requests for financial assistance shall be processed promptly and Ridgeview shall notify the patient/applicant within 30 days of receipt of completed application. 

MANAGING PATIENT ACCOUNT BALANCES

For patients who qualify for Financial Assistance and who are cooperating in good faith to resolve their discounted hospital bills, Ridgeview may offer extended payment plans, and will not send unpaid bills to outside collection agencies. Ridgeview will not impose extraordinary collections actions such as wage garnishments, liens on primary residences, or other legal actions.  Collection actions will not occur without first making reasonable efforts to determine whether a patient is eligible for charity care under Ridgeview’s Financial Assistance Policy.  Patients on financial assistance are offered very generous payment plans that will fit their financial condition.  Patient statements are sent to them to inform them on the account balance.  in situations where a patient under the financial assistance is unable to pay their account, Ridgeview does not seek any collection activities.  Furthermore, their account will not be reported to credit bureaus. 

PROVIDERS DELIVERING EMERGENCY AND MEDICALLY NECESSARY CARE

Ridgeview’s facility and all its providers are delivering emergency and medically necessary services to patients who qualify for Financial Assistance.

HOW to APPLY:

To apply for financial assistance, please click the link for the Financial Assistance Application Form, print it, and completely fill out the information. The form also asks for supporting documentation as follows:

• A complete copy of your most recent Income Tax Return and supporting W-2s
• Two (2) current paycheck stubs from adult members of the household
• If disabled or retired, send verification of current monthly Social Security and/or retirement benefits (e.g., letter from Social Security or current bank statement)
• If receiving Food Stamps, send verification of benefits
• If you are not employed, you must provide a dated, notarized letter from the person(s) providing help with living expenses

For any questions about our Financial Assistance Program, please contact our Client Services Department.

By telephone:            (865) 482-1076   Monday to Friday between 8 am and 5 pm Standard Eastern Time

By Email:                    contact@ridgeview.com

By US Mail:                 240 West Tyrone Road, Oak Ridge, Tennessee 37830 

Our Client Services staff at the clinics where you go for services are available to assist in availing of our Financial Assistance Program.

Please mail completed application to:

Ridgeview Psychiatric Hospital

Attn:  Financial Assistance

240 West Tyrone Road

Oak Ridge, Tennessee 37830

Copy of Ridgeview’s Financial Assistance Program as contained herein can be requested and will be mailed free of charge by contacting our Client Services Department.

REGULATORY REQUIREMENTS

In implementing this Policy, Ridgeview management and facilities shall comply with all other federal, state, and local laws, rules, and regulations that may apply to activities conducted pursuant to this Policy.