Charity Case Application

What is Charity Care?

A program that Great Plains Regional Medical Center has established that will help support the community needs of indigent patients. Great Plains Regional Medical Center will budget and fund a reasonable amount of Charity Care each year.

Requirements

An applicant must meet the following requirements set forth by Great Plains Regional Medical Center to be eligible:

Make application within sixty (60) days after the approval/denial from MEDICAID and/or any other program considered to be an alternate source of payment.

Denial due to non cooperation with any potential third party payor will constitute a denial for charity care.

Meet income guidelines of 200% of the Federal Poverty Guidelines set forth by the U. S. Department of Health and Human Services.

Have resources not to exceed $5,000.

Exception

Any inpatient Medicaid recipient with charges in excess of the allowable covered days will be exempt from the application process. All charges, except the amount Medicaid considers the patient’s responsibility, will be considered as charity care.

Application Eligibility

Patient’s, their families, or representatives must request Charity Care.

Applicants will have 60 days after being denied due to program eligibility in whole or part by Medicaid or any other program the hospital considers to be an alternative source of payment.

Applications received incomplete or without all required verification will be given one (1) notice to comply. If the information is not received within 30 days, the application will be denied.

Determination of eligibility will be made within one month upon receipt of a completed application. No determination will be made until all third party payments/denials are received.

Great Plains Regional Medical Center reserves the right to limit the amount of charity care approved once budgeted amounts have been reached.