Presbyterian Provides Financial Assistance to Patients in Need

As New Mexico's only private, not-for-profit healthcare system, Presbyterian Healthcare Services welcomes patients in need of medically necessary health care. We provide appropriate medical treatment to all patients regardless of their ability to pay for their care.

Presbyterian is a healthcare organization with a charitable purpose. In 2006, Presbyterian provided $20.4 million in free care, at cost, to patients unable to pay for their services. We encourage all patients who believe they are unable to pay for medically necessary services from any Presbyterian facility or provider to apply for financial assistance.

Presbyterian has a policy on financial assistance that provides free medically necessary services for patients with income up to 200% of the federal poverty guidelines. As an example, for a family of four, 200% of the 2006 federal poverty guidelines equals a household income of $40,000. Assets may be considered in determining patients who qualify for assistance.

Presbyterian provides sliding-scale discounts on medically necessary services for patients with income between 200-300% of the federal poverty guidelines. Using the same example of a family of four, 300% of the 2006 federal poverty guidelines equals a household income of $60,000.

Assets

Assets may be considered in determining patients who qualify for assistance.

In addition, Presbyterian provides a 15% discount on billed charges for self-pay patients (those without health insurance) who have income greater than 300% of the federal poverty level. Some exceptions apply.

Presbyterian financial services works with patients to arrange payment plans.
Finally, Presbyterian has a committee that reviews cases for patients of all income levels in which the patient's extraordinary medical bills merit special consideration. The committee may reduce or forgive medical bills in these cases.

Applying for Financial Assistance

• To apply for financial assistance, patients should visit the nearest Presbyterian facility and ask for a Patient Service Representative, or call us at (505) 923-6600 or toll-free at 1-800-251-9292. Our representatives will be happy to help with each of the steps that follow.
• The representative will first work with the patient to determine whether funding is available from other sources, such as Medicaid or county funds.
• As part of our policy, the patient will be asked to complete an application and supply personal financial information, including bank statements, paycheck stubs, and monthly expenses.
• Once all personal financial information has been supplied, a Presbyterian representative will determine whether the patient is eligible for financial assistance using the current Financial Assistance Determination Guide (.pdf).
• If the patient qualifies for financial assistance, then Presbyterian will forgive all or a portion of the patient's bill(s) for medically necessary services, in accordance with our policy.
• Patients who do not qualify, based on income, but believe their bills require special consideration may request that their case be reviewed for extraordinary circumstances by Presbyterian's committee.
• Patients and their families are encouraged to provide financial information in a timely manner so that Presbyterian can complete financial assistance applications within 10 business days.
• Patients may apply for financial assistance at any time by following our Financial Assistance Policy (.pdf).

Self-pay (without health insurance) patients with incomes greater than 300% of federal poverty guidelines do not need to apply for financial assistance in order to receive a 15% discount on their Presbyterian medical bills. Our patient financial services department will process this automatically. Some exceptions apply.

Medically Necessary Services

Medically necessary services are clinical and rehabilitative physical, mental or behavioral health services that are:

• Essential to prevent, diagnose or treat medical conditions or are essential to enable the individual to attain, maintain or regain functional capacity
• Delivered in the amount, duration, scope and setting that is clinically appropriate to the specific physical, mental and behavioral health care needs of the individual
• Provided within professionally accepted standards of practice and national guidelines
• Required to meet the physical, mental and behavioral health needs of the individual and are not primarily for the convenience of the individual, the provider or the payor

Most Healthcare Services Are Medically Necessary Services

Examples of services that are not medically necessary include, but are not limited to:

• Plastic surgery (for purely cosmetic purposes)
• Fertility drugs
• Operations to reverse voluntary sterilization
• Sex-change operations
• Experimental treatments

If you have questions about financial assistance, please call us toll-free 1-800-251-9292.