You Ask, We Answer: How much information is enough for Financial Assistance approval? 

By Nick McLaughlin

Question:

What are your best practices or procedures for patient cooperation to obtain the documents to qualify them for your Financial/Charity program?  Many times, a patient is denied not because they don’t qualify, but because they did not provide all the information we require with our application form. Also, what is the minimum amount of financial documents required to approve someone for charity? 

Answer: 

This is a question we get asked frequently. My first response is to ask the hospital a question in return – “How do you define an effective financial assistance/charity program (FAP)?” Is an effective FAP one that focuses on making sure no one who does not qualify receives financial assistance? Or is an effective FAP one with a balanced focus on getting the patients that need help on the program and requiring patients with ability to pay, to pay? At Breez we advocate for a balanced approach. 

One of the primary culprits that sabotage the effectiveness of a hospital’s FAP are long lists of required documents. The trouble with heavy documentation requirements is two-fold (at least): 

  1. Many patients who do qualify for charity based on their situations get denied either because of an incomplete application or they found the application process too much of a hassle to attempt to navigate. This results in many charity-eligible patients, unable to pay, clogging up your billing workflows and winding up in collections. 
     
  1. It also creates a burden on your hospital finance team. Long lists of required documents create a lot of work to review and process for hospital staff. The more paperwork a hospital expects patients to submit, the more paperwork their team has to review. 

Presumptive charity solutions certainly can play a role with FAP, however, I’ve spoken to many organizations who have implemented broad-stroke presumptive solutions and then significantly dialed back their usage due to a lack of precision. 

We advocate for an application-based approach that includes only the minimum necessary information needed to approve/deny financial assistance, while maintaining the integrity of the program. This leverages the FAP process as a key point of patient engagement to ensure any billable insurance information is collected (yes, we recommend asking for insurance information on the FAP application), while gathering financial information from the patient which will either qualify them for full FA, a partial discount, or route them to a payment plan or patient financing solution. 

The goal is to collect from patients with the ability to pay and approve appropriate FA discounts for those who need the help. 

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