Financial assistance
In keeping with TMC Health’s commitment to deliver caring, personalized, quality health care, our services are made available to all patients regardless of ability to pay. Our Community Care program sets forth TMC Health's financial assistance for qualified patient accounts
Select the link below to read our policies and download the financial assistance program application:Documentos en español
$251-500: 5 months
$501-1,000: 7 months
$1,001-2,000: 13 months
$2,001-3,000: 18 months
$3,001-4,000: 22 months
$4,001 and higher: 24 months
Community Care program overview
To further the TMC Health mission to the communities it serves, we provide financial assistance for medically necessary health care in a fair, consistent, respectful and objective manner to low-income patients who do not have insurance coverage or are underinsured.Our Community Care Policy covers patients who lack the financial resources to pay for all or part of their bill and to process appropriate adjustments for hospital charges. Our financial representatives will consult with the patient and patient's family to identify state or federal resources available to cover the cost of care. This frequently involves obtaining health coverage through the Arizona Health Care Cost Containment System, or AHCCCS. This financial consultation can occur either after care is provided or in advance of a planned hospital stay.If coverage is not available, the patient may request financial assistance. Requests are reviewed on a case-by-case basis with eligibility determined based on the U.S. Health & Human Services current year’s federal poverty guidelines. The current year’s sliding scale contains discounts applied up to 400 percent of the federal poverty level on the amount owed by the patient/guarantor after insurance coverage has been applied.For example, a family of four with an annual income of $39,750 a year is at 150% of the poverty level, making it eligilble for an 80% discount of the amount it owes after insurance coverage is applied. If the family had an insurance policy that covered 90 percent of a $10,000 bill, then this family is given an 80% discount on the $1,000 balance for which it is responsible. The final bill from TMC would be $200 for this family.The information that follows on our financial assistance program, or Community Care, is provided for download in the documents above.Definitions
Look back method: Calculation of all claims paid in a 12 month period by Medicare fee for service and Insurance Companies. This amount calculated is then divided by the full total charges of those claims in order to get the calculated number for the “amount generally billed” (AGB).Medically necessary: Refers to inpatient or outpatient health care services provided for the purpose of evaluation, diagnosis and/or treatment of an injury, illness, disease or its symptoms, which otherwise left untreated would pose a threat to the patient’s ongoing health status. Services must be clinically appropriate and within generally accepted medical practice standards, represent the most appropriate and cost effective supply, device or service that can be safely provided and readily available at Tucson Medical Center with a primary purpose other than patient or provider convenience. Expressly excluded from medically necessary services are: healthcare services that are cosmetic, experimental, part of a clinical research program, private and/or non-TMC medical or physician professional fees, or services and/or treatments not provided at a TMC.Uninsured: Those who are not eligible for coverage that would otherwise pay for medical services (whether through employer-based coverage, commercial insurance, government-sponsored coverage, or third-party liability coverage.)Underinsured: Those who have health insurance (including employer and individual exchange plans) but face deductibles and health care costs that are high in relation to their income.Statement of Policy
Community Care and Financial Assistance Process is in keeping with TMC Health’s commitment and our mission to deliver caring, personalized, quality health care, services will be made available to all patients regardless of ability to pay. True self-pay patients, those denied for preexisting conditions, not eligible on dates of service or non-covered benefits with the exception of elective package pricing, automatically receive a discount. When appropriate TMC Health staff should determine if a patient account qualifies for community care. Services provided to patients when payment is not anticipated because of an inability to pay. Financial assistance is available through Tucson Medical Center’s (TMC’S) “Financial Assistance Policy” (FAP) program. This policy is also known as our Community Care Policy. The FAP is separate and distinct from Bad Debts, which are accounts in which credit has been extended and payment is anticipated, but not received. Following the determination of FAP-eligibility, an FAP-eligible individual will not be charged more for emergency or other medically necessary care than the "amounts generally billed” (AGB) to individuals who have insurance covering such care. The methodology used by Tucson Medical Center to calculate AGB is the look-back method. Members of the public may readily obtain the current AGB percentage and a description of how it is calculated by contacting TMC Patient Financial Services at (520) 324-1310.Consistent with its mission statement, TMC will provide available and necessary health care services, including emergency medical conditions, to patients regardless of their: disability, sexual orientation, gender expression, age, sex, race, religion, creed, national origin, or ability to pay.TMC assists eligible persons without insurance coverage or who are underinsured by waiving all or part of the charges for services provided by TMC.Services covered: hospital-based services
This policy covers the hospital technical services provided in the hospital and other free-standing outpatient departments, including but not limited to:- Tucson Medical Center-hospital services (emergency care, medical/surgical services, intensive care, mother/baby, pediatrics and outpatient departments within the hospital)
- TMC for Women Breast Center
- Adult and Pediatric Therapy
- Infusion Center
- Sleep Lab
- Pain Clinic
- Wound Center
- Diabetic Education
Services not covered: physician fees not covered
This policy does not cover physician fees (also known as “professional fees”) for emergency, and other medically necessary care provided by physicians and certain other medical providers who treat patients seen at Tucson Medical CenterMore specifically, this policy does not cover professional fees for emergency and other medically necessary care provided by the following types of physicians:- Emergency Department physicians
- Hospitalists/Laborists
- Internists
- Radiologists and Radiology groups
- Anesthesiologists and Anesthesia groups
- Pathology
Additional services not covered
Cosmetic surgeries are generally considered to be elective procedures that are non-emergent and not medically necessary care (as defined below) and are excluded from this policy.Applying for financial assistance, determination and payment
Completing the Community Care application
- Patients wishing to apply for financial assistance must complete a Community Care application within 30 days of discharge. Otherwise, a patient will continue to be billed.
- A copy of the Community Care application may be downloaded with this link; may be requested by calling the Business Office at (520) 324-1310; may be requesting by mailing the TMC Business Office, PO Box 42195 Tucson, Arizona, 87533; or may be requested in person at the Business Office, 1400 N. Wilmot Road, Tucson, Arizona, 85712
- Completion includes filling out and submitting a Community Care application, along with all requested documentation of income and assets, to P.O. Box 42195, Tucson, Arizona, 85733 or faxed to (520) 324-3004.
- Documentation provided with the completed Community Care application must include, as applicable: copies of Social Security cards, proof of residency, bank or credit union statements for the last three months, investment statements for the last three months, W-2s or other wage or income information such as three months of payroll stubs, Social Security checks, or unemployment checks, self-employment business records, income award letters/grant of education benefits, or other documents showing income and assets, a copy of the current IRS tax return, mortgage statements and annual property tax statements, and documents evidencing the relationships of household members, including birth or baptismal certificates, adoption papers, marriage license, divorce decree or legal separation documents. TMC may request additional documentation during its application review.
Eligibility criteria for patient financial assistance
- The Community Care Policy employs a sliding-scale discount that takes into consideration a patient’s household income and assets.
- Eligible patients are uninsured or underinsured persons who receive inpatient or outpatient medically necessary services from any TMC location and both the following apply:
- Financial assistance determinations will be consistent among patients regardless of their age, sex, race, religion, creed, disability, sexual orientation, national origin or immigration status.
- Financial assistance is generally secondary to all other financial resources available to the patient, including insurance, government programs, third-party liability and qualified assets.
- Individuals with access to health insurance, third-party reimbursement for health services or governmental assistance who refuse to enroll, fail to take advantage of, or fail to maintain eligibility for such coverage may be excluded from receiving financial assistance.
- Hospital Community Care application information may be used for a period of six months for qualification. After six months, a new application may be required to qualify new services for charity.
- Patient Financial Services Rep: $0 - $3,000
- Supervisor: $3,001 - 10,000
- Patient Financial Services Manager: $10,001 - $25,000
- Director of Revenue Cycle Services: $25,001 and higher
Financial assistance determination process
- The qualifying level of assistance for patients eligible for Community Care will be based on TMC’s billed charges. Patients that qualify under the Community Care Policy will not be charged more than the amounts generally billed (AGB) for services rendered. AGB is calculated annually by determining the average percentage paid for services rendered to Medicare and private insurance payers. A copy of this calculation is available upon request by calling the Business Office at (520) 324-1310. Thereafter, financial assistance will be determined using a sliding-fee scale based upon Household Income as compared to the Federal Poverty Level (FPL) and subject to a reduction based on Qualifying Assets. Financial assistance discounts will be applied to the amounts generally billed (AGB).
- In order to obtain financial assistance, the patient must establish (through completion of a FAP application and submission of required documentation) that the patient’s Household Income is below 400% Federal Poverty Level (FPL).
- Allowances may be made for extenuating circumstances based on each person’s unique life situation and mitigating factors. The amount of assistance provided by TMC may be more than outlined in the TMC FPL Grid for the current year but not less.
- Documents used for income and assets verification for the household include but are not limited to: copies of the most recent 90 days of payroll stubs, Social Security checks, or unemployment checks; copy of the current IRS tax return filed; current bank, trust fund statements, mortgage statements and annual property tax statements. In the absence of income, a letter of support from individuals providing for the patient’s basic living needs may be provided. Upon request TMC may require additional verification of income and assets.
Payment plans for patients approved for financial assistance
Guidelines for payment plan amounts:Amount Owed - Months to Pay$75-250: 3 months$251-500: 5 months
$501-1,000: 7 months
$1,001-2,000: 13 months
$2,001-3,000: 18 months
$3,001-4,000: 22 months
$4,001 and higher: 24 months
- If a payment plan needs further extension, the Business Office must be contacted at (520) 324-1310.
- Community Care patients meeting an agreed upon monthly payment plan will not be assigned to a collection agency.
- Patients are responsible for communicating to the Business Office anytime an agreed upon payment plan may be broken. Lack of communication from the patient may result in further account collection action after appropriate patient notification.
- Payment plans extending beyond the recommended timeframe are accepted based on supporting documentation or adequate security with manager approval.
- Payment plans extending beyond the recommended time frame with no supporting documentation may be forwarded to the collection agency for extended payments. These may be interest-free with no legal action pursued as long as the payment plan is maintained.
Appeals of assistance determinations
Patients or their representatives may appeal a financial assistance determination by providing additional information demonstrating eligibility, such as income verification or an explanation of extenuating circumstances, to the business office within 30 days of receiving the NOD. The Patient Financial Services Manager and the Director of Patient Financial Services will review all appeals. The responsible party will be notified of the outcome.Collection practices for Community Care patients
- If a patient does not make payment and fails to initiate the financial assistance process, TMC will continue to bill the patient for at least 120 days and may elect to begin collection activity including possible transfer to a collection agency. Prior to transferring to a collection agency, TMC will send a minimum of three statements every 30 days or make two phone calls on accounts with returned mail in an attempt to contact the patient at the address and phone numbers provided by the patient and to ensure the account has reached at least 241 days in delinquency. Statements and communications will inform the patient of the amount due, of the opportunity to complete a FAP application, and that the completion of the application may qualify the patient for free or reduced cost care.
- Accounts older than 241 days from discharge and that have been referred to a collection agency may be reported to a Credit Bureau agency.
- Agencies contracted with TMC will provide patients the TMC 24- hour phone number that patients may call to request financial assistance if financial assistance is requested by the patient while in collections
- Patients whose accounts have been transferred to a collection agency may request TMC financial assistance, submit a Community Care application with requested documentation and be considered for reduction of their bill. These patients will be subject to a stay of collection activities described in the preceding paragraph.
- Patients sent to collections and are making payments will not be reported to the Credit Bureau
Accounting for charity care
- A separate file will be maintained for accounts written off as charity care and retained in the Business Office for a minimum of two years.
- Staff will use the “Approval of Application for Charity Care” form when the receivable is approved for write-off.
Communications to patients
- TMC is committed to making the people in the communities it serves aware of the availability of financial assistance through its Community Care Policy. TMC will provide financial counseling to patients upon request and help those who are eligible through the Community Care application process.
- TMC communicates the availability of financial assistance in appropriate acute-care settings such as Emergency departments, registration areas and on the hospital website.
- All billing statements and statements of services will inform patients that financial assistance is available.
- Signs are posted in hospital registration areas informing patients that financial assistance is available for qualifying patients who complete an assistance application. These signs inform patients that free or reduced-cost care maybe available to qualifying patients who complete an application.
- Materials describing the Community Care Policy, including cards and brochures, are available in English and Spanish on the hospital website, in Admitting and at the Business Office.
- Financial counseling and Business Office personnel are available at the hospital or at the Business Office to assist patients in understanding and applying for local, state and federal health care programs and the TMC Community Care.
- Reasonable efforts are made to ensure that all TMC employees are informed about how to refer patients to apply for TMC Community Care. Annual staff education programs are provided to all Business Office and Admitting staff.
- Patients can request financial-assistance information or a copy of this policy or the Community Care application by calling the Business Office, (520) 324-1310. Voicemail is available and calls will be followed up within two working days.
- Patients are provided information regarding the availability of financial assistance upon registration or admission to TMC’s acute-care areas.
- This policy and the Community Care application for assistance in the form of the TMC Financial Assistance Program are available at the top of this webpage, in acute-care inpatient registration areas or via mail from the Business Office. The Community Care application documents include instructions on how to complete the application form and the kinds of supporting documentation that are needed to complete the application process. Instructions for return of the form are also provided.
- Individuals other than the patient, such as the patient’s physician, family members, community or religious groups, social services, or hospital personnel, may make requests for financial assistance on a patient’s behalf.
- Non-covered charges for Medicaid patients are considered charity allowances.
