September 22, 2015Dear [redacted]:I am writing to you to follow-up on your email sent to Patient Relations regarding your bill for services rendered at Suburban Hospital in December of 2011. We have carefully reviewed your concerns and can provide you with the following information. Your concerns...
were forwarded to the Directors of Managed Care and Patient Account. The following is a summary of their investigation.On December 2, 2011, you arrived to Suburban Hospital for care. At that time, you informed the registration staff that you did not have insurance. A Financial Assistance for was given to you at that time. The registration staff explained to you:1. The application should be returned to Suburban Hospital with all required substantiating documentation.2. It was your responsibility to complete the form in an accurate, honest, and complete manner.3. Failure to do so may result in denial of your application.On February 8, 2014 you called Patient Access stating that you had lost the Financial Assistance form and requested another be sent. At that time, your address was verified and a copy of the form sent to the address given. When no form or substantiating document were received, your account was placed in collection and notice was sent to your address on April 26, 2014. Another copy of the Financial Assistance form was sent to you on May 6, 2012 and July 8, 2014 per your request. A completed form was not received by Patient Account until December 1, 2014. Ann M[redacted] forwarded the information to the attorneys that handle accounts that are in collection. Since the data on the application was over two (2) years old, the attorneys wanted updated financial information which resulted in a denial of your application.Presumptive Financial Assistance EligibilityThe presumption of finance assistance eligibility can be negated if the patient the patient fails to provide proof of the life circumstances set forth in [redacted] The proof must be provided within thirty (30) days of treatment unless the patient requests an additional 30 days for a total of sixty (60) days. When that time period has past, the financial assistance form must be accompanied by copies the most recent Federal Income Tax Return and three (3) most recent pay stubs.Maryland Legislation 2005 HB 627Community Health Care Access and Safety Net Act of 2005 (HB 627) requires hospitals to develop financial assistance policies to provide free and reduced-cost care to certain patients. [redacted] Medicall institutions has a robust “Financial Assistance” policy that you have referenced in your email to Patient Relations.Equitable defenses LachesLaches is a type of equitable defense wherein a plaintiff is prevented from bringing a claim because they delayed too long in filing it. In order for a laches defense to succeed, the defendant must also prove that the plaintiff’s delay in bringing suit resulted in some sort of prejudice or economic injury such as lost profits. Since it is an equitable defense, laches is only available in claims where the plaintiff is seeking equitable relief such as an injunction or specific performance of the contract. Laches is not available in claims involving money damages.Equitable Estoppel/Refusal to process submitted Financial Assistance applicationThe elements that must be established to prove an equitable estoppel are: (1) the party against whom the cstoppcl is sought must have made a representation about a material fact that is contrary to a position it later asserts; (2) the party claiming estoppel must have relied on that representation; and (3) the party seeking estoppei must have changed his position to his detriment based on the representation and his reliance on it. There can be no estoppel when the party seeking the estoppel was aware of the true facts and thus was not misled by the other party's conduct.Ann M[redacted] did not make representations that you could have rclied upon to your detriment. She accepted your documentation for review and sent it on to the appropriate parties per the HHS Financial Assistance Policy. Per policy, the documentation sent must be the most recent information. Since the application was not received until two years after the date of service that you were applying for, the attorneys appropriately requested more recent information in order to determine your ability to pay the outstanding balance.Negotiation of Account BalanceOnce an account has been placed in collection and is in the hands of the account collection attorneys, the Patient Accounts departments lacks the authority to negotiate a lower balance. Ali negotiation must be made with the account collections attorneys handling the case. At this time, your account has been in the hands of the account collection attorneys and all negotiation for a lower balance must be made through them.Based on the available information, I must decline your request that we reduce the charges for the care provided to you. Our charges were for services that we provided in good faith and in accordance with community standards.We trust we have sufficiently addressed your concerns and consider this matter resolved as of September 22, 2015. If you are not satisfied with the outcome of our grievance process, you may contact Tresa F[redacted] at [redacted].Sincerely,Frances SRN, JD Associate Risk Manager
September 22, 2015Dear [redacted]:I am writing to you to follow-up on your email sent to Patient Relations regarding your bill for services rendered at Suburban Hospital in December of 2011. We have carefully reviewed your concerns and can provide you with the following information. Your concerns...
were forwarded to the Directors of Managed Care and Patient Account. The following is a summary of their investigation.On December 2, 2011, you arrived to Suburban Hospital for care. At that time, you informed the registration staff that you did not have insurance. A Financial Assistance for was given to you at that time. The registration staff explained to you:1. The application should be returned to Suburban Hospital with all required substantiating documentation.2. It was your responsibility to complete the form in an accurate, honest, and complete manner.3. Failure to do so may result in denial of your application.On February 8, 2014 you called Patient Access stating that you had lost the Financial Assistance form and requested another be sent. At that time, your address was verified and a copy of the form sent to the address given. When no form or substantiating document were received, your account was placed in collection and notice was sent to your address on April 26, 2014. Another copy of the Financial Assistance form was sent to you on May 6, 2012 and July 8, 2014 per your request. A completed form was not received by Patient Account until December 1, 2014. Ann M[redacted] forwarded the information to the attorneys that handle accounts that are in collection. Since the data on the application was over two (2) years old, the attorneys wanted updated financial information which resulted in a denial of your application.Presumptive Financial Assistance EligibilityThe presumption of finance assistance eligibility can be negated if the patient the patient fails to provide proof of the life circumstances set forth in [redacted] The proof must be provided within thirty (30) days of treatment unless the patient requests an additional 30 days for a total of sixty (60) days. When that time period has past, the financial assistance form must be accompanied by copies the most recent Federal Income Tax Return and three (3) most recent pay stubs.Maryland Legislation 2005 HB 627Community Health Care Access and Safety Net Act of 2005 (HB 627) requires hospitals to develop financial assistance policies to provide free and reduced-cost care to certain patients. [redacted] Medicall institutions has a robust “Financial Assistance” policy that you have referenced in your email to Patient Relations.Equitable defenses LachesLaches is a type of equitable defense wherein a plaintiff is prevented from bringing a claim because they delayed too long in filing it. In order for a laches defense to succeed, the defendant must also prove that the plaintiff’s delay in bringing suit resulted in some sort of prejudice or economic injury such as lost profits. Since it is an equitable defense, laches is only available in claims where the plaintiff is seeking equitable relief such as an injunction or specific performance of the contract. Laches is not available in claims involving money damages.Equitable Estoppel/Refusal to process submitted Financial Assistance applicationThe elements that must be established to prove an equitable estoppel are: (1) the party against whom the cstoppcl is sought must have made a representation about a material fact that is contrary to a position it later asserts; (2) the party claiming estoppel must have relied on that representation; and (3) the party seeking estoppei must have changed his position to his detriment based on the representation and his reliance on it. There can be no estoppel when the party seeking the estoppel was aware of the true facts and thus was not misled by the other party's conduct.Ann M[redacted] did not make representations that you could have rclied upon to your detriment. She accepted your documentation for review and sent it on to the appropriate parties per the HHS Financial Assistance Policy. Per policy, the documentation sent must be the most recent information. Since the application was not received until two years after the date of service that you were applying for, the attorneys appropriately requested more recent information in order to determine your ability to pay the outstanding balance.Negotiation of Account BalanceOnce an account has been placed in collection and is in the hands of the account collection attorneys, the Patient Accounts departments lacks the authority to negotiate a lower balance. Ali negotiation must be made with the account collections attorneys handling the case. At this time, your account has been in the hands of the account collection attorneys and all negotiation for a lower balance must be made through them.Based on the available information, I must decline your request that we reduce the charges for the care provided to you. Our charges were for services that we provided in good faith and in accordance with community standards.We trust we have sufficiently addressed your concerns and consider this matter resolved as of September 22, 2015. If you are not satisfied with the outcome of our grievance process, you may contact Tresa F[redacted] at [redacted].Sincerely,Frances SRN, JD Associate Risk Manager