Financial Assistance/Uncompensated Care
Mason General Hospital & Family of Clinics has a Financial Assistance/Uncompensated Care Policy. This policy contains the guidelines for people to follow if they need any assistance with payment of their hospital bills. This policy applies to those who who do not have insurance AND those who have insurance, and is based on income levels. Please ask at the Admitting area or the Business Office for a copy of the guidelines and an application. Completed applications should be sent or delivered to the Business Office.
Hospitals which are nonprofit and recognized as 501(c)(3) organizations (including Public Hospital District No. 1 of Mason County) shall limit amounts charged for emergency or other medically necessary care provided to individuals eligible for assistance under this Financial Assistance Policy to not more than the amounts generally billed to individuals who have insurance covering such care and may not collect “gross charges” from such individuals. See requirements WAC 246-453-040 and WAC 246-453-050 and IRS 501(r). This financial assistance update is effective for dates of service beginning January 1, 2016. Elective services are not covered under our Financial Assistance Policy or the 501(r) requirements.
Our Uncompensated Care Program is based on a sliding fee schedule extending up to 400% of the federal poverty level. In order to qualify you need to do three things:
- Complete the Uncompensated Care application
- Provide proof of income so that we can verify household income for the previous 12-month period
After all the criteria have been met, a determination will be made based on the income information. You may qualify for a discount of up to 100% of your bill
Financial arrangements must be made prior to admission for any pre-scheduled services. A deposit will be requested for emergency services. For those with insurance coverage, co-payments and deductibles are expected at the time of service. If payment arrangements are needed, they must be set up within 15 days from the date of service. Payment arrangements are required whenever the bill cannot be paid in full at the time of the first billing statement. The guarantor is responsible for making appropriate financial arrangements with the Business Office. If payment arrangements are needed, the payment schedule is as follows:
For services that are the result of a work related injury the Business Office will need the following information:
- Employer name, address and phone number
- Date of injury
- Claim number, if applicable
You must notify your employer of an on-the-job injury. Your employer will need to submit additional information to the industrial carrier. Mason General Emergency Room physicians can not help you with re-opening a closed claim. You will need to go to your primary care physician for this service.
For services related to a motor vehicle accident, the Business Office will submit a bill on your behalf once the following information is received:
- The name of the responsible party
- The name and phone number of the responsible party's insurance carrier and agent's name
- The guarantor's auto insurance company name, phone number, and Agent name
- Any claim numbers assigned to you for this particular accident
Mason General Hospital & Family of Clinics will not wait for litigation with regard to an accident. It will be your responsibility to pay the bill in a timely manner if insurance does not pay timely.
Mason General Hospital & Family of Clinics will bill your insurance company if all needed information and a copy of your insurance card is presented at the time of registration. At the time of registration, you will be asked to sign a form authorizing your insurance company to assign insurance benefits to Mason General Hospital & Family of Clinics. You are expected to pay for charges that are not covered by insurance such as co-payment, coinsurance, non-covered and deductible amounts. Questions regarding insurance coverage or benefits must be directed to your insurance company. Is it your responsibility to know and meet the requirements of your insurance policy for pre-approval of your hospital service(s).
- Champus (Tricare)
- Community HealthPlan of Washington - Medicare Advantage and Washington Health Plan Only (General Assistance Coupon)
- First Choice
- Great West Healthcare Molina
- Group Health HMO (SFM, Olympic Physicians, Shelton Ankle & Foot only)
- Group Health PPO (Hospital & Clinics)
- Health Options and PEBB
- Healthy Options - Amerigroup, Coordinated Care, Molina
- Humana ChoiceCare
- Kitsap Physicians Insurance
- Medicare Advantage
- Noridian Medicare
- Pacificare HMO Commercial
- Pacificare HMO Secure Horizons
- Pacificare PPO and EPO
- Premera Blue Cross
- Regence, Blue Shield
- Regence, Boeing
- Skokomish/Squaxin Indian Health
- Uniform Medical Plan
- United Healthcare - Commercial Plans Only with Hospital Services
- Washington Medicaid
If you have questions relating to a provider’s preferred, participating, network or non-network status, please refer those questions to your insurance company. The patient is responsible for meeting the requirements of their insurance policy and all questions regarding insurance coverage or benefits must be directed to your insurance company.
Contact Us for Financial Assistance
Mason General wants you to understand your hospital bill. If you have any questions please call (360) 427-3601; from Allyn call (360) 275-8614 and ask for the Patient Accounts Office. A Spanish translator is available.
2505 Olympic Hwy, Suite #450
Shelton, WA 98584
CUSTOMER SERVICE HOURS
Monday - Friday: 8 a.m. - 4:30 p.m.