1.

All patients registered as private pay (no insurance provided) will receive a discounted billing, except for Providence-Holy Cross Medical Center (PHCMC) patients potentially eligible for AB75 reimbursement. The discount will constitute the maximum amount due. Patients will receive a handout during the registration process that explains the discount and the various options to pay for the health care billing. In addition, patients will receive a letter explaining these options with the initial billing. Those documents are incorporated as attachments to this policy.

2.

The PHCMC Trauma patients will be billed at retail charges during the screening process, by utilizing PATCOM insurance code 9950. Upon determination that the patient is not eligible for AB75 reimbursement, the insurance code will be changed to 9900, appropriate discounts applied per ADDENDUM 1, and the account will be managed as a self pay account per the terms of this policy.

3.

The discount will be calculated by the billing systems when the final billing of itemized charges is generated. The discount rates in ADDENDUM 1 for the applicable date of service will be applied to determine the financial liability.

4.

The patient will receive a letter of explanation with the initial billing and will be asked to sign an acknowledgment of PHSCA requirements for a private pay discount. That letter and acknowledgment will advise that the patient will owe only the discounted amount due to assure that the amount payable is an equitable rate, comparable to rates paid by government agencies, managed care contracted payers and other third party payers. The letter will also advise the patient to contact the Business Office Customer Service Representatives if there are questions regarding the billing, if payment arrangements are needed, or if financial assistance is needed (Medi-Cal enrollment or Charitable Assistance). The document will further state that Providence will not provide a private pay discount for an insured patient who wishes to pay the private pay discount and bill insurance privately to receive perhaps larger reimbursement. Accordingly, courtesy billing or the provision of a third party claim (UB92 or HCFA 1500) will not be permitted for private pay patients.

5.

Both the San Fernando Valley and Little Company of Mary Service Areas provide prompt payment programs for specialized services for private pay patients. To receive these prompt pay services, the patient must pay in full at the time of service.

6.

If the prompt payment rate amount is not paid at time of service, the prompt offer is null and void, and the private pay discounts per this policy will apply

7.

The discount transaction code will be separately identifiable in the accounts receivable transaction reports of the California Regional facilities. The discount, once applied, will establish the permanent liability due by the patient. It will not be reversed, except for charity write-offs. It will be titled PRIVATE PAY DISCOUNT.

8.

Should the account remain unpaid and be qualified for transfer to bad debt, the amount transferred will be the net liability due (the discount remains in effect) and all collection efforts, including legal action, will be against the net liability due.