Hospital Uninsured Patient Discount Act SB 2380
SB 2380, the Hospital Uninsured Patient Discount Act, became law September 23, 2008 and the provisions of law apply to hospitals beginning April 1, 2009. The Act requires all hospitals to provide discounts from charges to uninsured patients meeting certain eligibility criteria. The discounts must result in bills of no more than 135% of cost. There is also a maximum collectible amount of 25% of annual family income for those who meet the eligibility criteria and do not have significant assets.
Major provisions of the Act are as follows:
Eligible PatientA hospital patient without any health insurance or coverage.
Patient must be an Illinois resident.
Family income no more than 300% Federal Poverty Level.
Example: Family of four; 300% FPL is $63,600.
Discount AllowedCharges are discounted to 135% of cost by applying the Cost of Charge Ratio from most recently filed Medicare Cost Report.
Applies to charges exceeding $300 in any one inpatient admission or outpatient encounter.
Maximum amount collected in a 12-month period from an eligible patient is 25% of family's annual gross income. Time period begins as of the first date of service determined to be eligible for discount. A hospital may exclude a patient from the 25% maximum collectible amount who has substantial assets. Assets not considered are primary residence, personal property exempt from collections, and any amounts held in a pension or retirement plan.
Eligible ServicesMedically necessary health care services that would be covered under Medicare for beneficiaries with the same clinical presentation as the uninsured patient.
Notice to PatientCriteria of and how to apply for the uninsured discount must be included on or with each hospital bill, invoice or summary of charges.
Patient ResponsibilitiesMay be required to apply for Medicare, Medicaid, AllKids, SCHIP, or other public program if there is reason to believe they would qualify for such program.
Patient may apply for the discount within 60 days of service.
Patient must provide third-party verification of income, information regarding assets and documentation of residency within 30 days of request.
Patient must inform hospital that he/she had received prior services from that hospital which were determined to be eligible for discount in order for any subsequent services to be included in the 25% maximum.
Protections/EnforcementsLaw cannot be used by public or private insurers to reduce hospital payment rates.
Law will not require a hospital to provide any particular service to an uninsured patient.
Law will not reduce any obligations under the Fair Patient Billing Act.
If you feel you meet the criteria stated and would like to apply for the discount, please contact Brice D. Harsy, Controller, at (618) 542-2146, ext. 1420, or Marilyn Zak , Credit and Collections, at (618) 542-2146, ext. 1422.