By MAUREEN PICHÉ

POTSDAM – Uninsured or underinsured people needing services at Canton-Potsdam Hospital have a little-known ally on their side when it comes to paying the bill: the hospital’s financial assistance program.

Karen Edwards, the hospital’s new director of the revenue cycle, says self-pay patients who don’t qualify for Medicaid may be eligible for the non-profit’s equivalent, which covers hospital costs on a sliding scale depending on need—sometimes up to 100 percent.

“I think all of us in healthcare know the uninsured are really having problems,” Edwards said. “In many cases, we’re able to help.”

All New York State not-for-profit hospitals are required to offer a financial assistance program, but Edwards said most, including Canton-Potsdam Hospital, were doing it before the policy was put in place in 2007. The money comes from the operating budget, and a small percentage is reimbursed annually by the state, based on hospital need.

“Both morally and legally, we need to accept everyone who comes here,” said Rebecca Sutcliffe, hospital spokeswoman. “It’s part of our mission. We are a safety net for the community.”

Edwards said the assistance program isn’t well known in the community. Her staff still spends a good deal of time trying to collect debts long after the patient receives care.

“Once someone receives a hospital bill, all they need to do is contact my office to work out a payment plan,” she said. “Part of it is that people don’t know there’s help, or they’re not willing to jump through the hoops.”

She added that all hospital bills now come with contact information for the program.

In 2009, 445 people applied for the financial assistance and 416 applications were approved, according to hospital statistics. The total dollars allocated to the program for 2009 were approximately $768,000.

Edwards explained when a financially strapped self-pay patient contacts her office, her staff will initially point them toward Medicaid. The paperwork is filled out with the assistance of hospital staff, the patient must gather the required documentation, and then the application is submitted for approval.

If the patient doesn’t qualify for Medicaid, or refuses to apply for religious or cultural reasons, her staff will then move the same information over to the hospital’s financial assistance program. The same documentation is needed, but the application is one page.

People can qualify with income and assets up to 300 percent above the federal poverty guidelines, she said. “We’re much more lenient than Medicaid,” she noted.

If accepted into the program, the patient’s bill ($100 or above) is placed on a sliding scale, based on the percentage above the federal poverty line. If a person is rated at 200 percent above the line, they will receive 46 percent off their bill. Then the remaining 54 percent can be placed in a payment plan spread out over months. Each plan is decided on a case-by-case basis.

Patients are then issued a card for financial assistance up to one year from acceptance, pending no changes in financial or asset status. “That becomes your insurance card,” Edwards said.

The same percentage and sliding scale is used for all hospital care deemed medically necessary, whether it’s blood work ordered by a doctor, a trip to the emergency room, or surgery.

Edwards said she is working to move her department away from a post-care collections model, and toward a front-end financial service provider. In this way, the moment a patient pre-registers for care, the patient—and the hospital—will know how the bill will be paid.

This will likely cut down on patient stress and the costly collections process, she said.

“We want to provide true financial counseling,” Edwards said. “I would much rather have somebody call and work with us rather than feeling frustrated, there’s no point, they won’t qualify.”

Edwards said information on the program and application forms will be online at the hospital’s website in the near future. For now, those wishing to find out more may contact hospital credit counselors at 261-5147.