Uninsured/Under-insured Patient Discount Policy (Non-Emergency

Last Approved Date: 09/13/2019

Policy Title: Uninsured/Under-insured Patient Discount Policy

(Non-Emergency Services)

Page 1 of 7

Departments: All Departments

Key Words: Discount, uninsured, patient

discount

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I. PURPOSE

The purpose of this Policy is to define the eligibility criteria for discounts offered to patients who

receive hospital services at Stanford Health Care (SHC or hospital) and who are uninsured. This

policy is intended for Uninsured Patients. Patient balances post-insurance processing are generally

excluded from this discount, including co-payments, co-insurance and insurance deductibles unless

specifically noted in this policy.

II. POLICY

SHC is committed to consistently providing a fair discount to individuals who are uninsured, or, in

some cases, insured but without insurance coverage for certain medically necessary healthcare

services offered by SHC, but who are not eligible for the Financial Need Discount set forth in the

hospital’s Financial Assistance/Charity Care Policy. These discounts reflect a desire by SHC to

respond to the individual financial situations of its patients, while satisfying its not-for-profit and

teaching missions, and meeting its strategic, operational, and financial goals.

This Policy establishes the guidelines for an Uninsured Patient Discount. Discounts may be offered

to patients residing in the United States or internationally for hospital services provided by SHC and

physician services provided by Stanford University employed faculty physicians.

III. PROCEDURE

A. UNINSURED PATIENT DISCOUNT – GUIDELINES

1. Definition of Uninsured Patient Discount:

a. Under the Uninsured Patient Discount, SHC shall limit the expected payment by an

Uninsured Patient for medically necessary hospital and physician services, as those terms

are defined below, to an amount determined by SHC to be within a range between the

average discount from billed charges for all commercial fee-for-service managed care

payers and the least discount extended to any managed care payer, provided that the

patient balance is either fully paid or arrangements are made with SHC for a payment

plan, within 90 days of the initial statement. Discounts are contingent on full payment of

the agreed amount. The Uninsured Patient Discount amount will be reviewed on a

quarterly basis and is subject to change at any time without notice. For current Discount

rate information, see Attachment A.

Last Approved Date: 09/13/2019

Policy Title: Uninsured/Under-insured Patient Discount Policy

(Non-Emergency Services)

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Departments: All Departments

Key Words: Discount, uninsured, patient

discount

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b. If a patient wishes to seek financial assistance greater than the current Uninsured Patient

Discount, the patient is referred to the SHC Financial Assistance/Charity Care Policy, and

may complete a Financial Assistance Application pursuant to that Policy.

2. Eligible Services:

a. The Uninsured Patient Discount shall apply to medically necessary hospital services

provided at or by SHC. In addition, the Stanford University employed faculty physicians

(Stanford Physicians) have agreed that the Uninsured Patient Discount under this Policy

shall also apply to medically necessary physician services provided at SHC by Stanford

Physicians. (Patients who are treated by a physician who is not a Stanford physician may

contact their physician directly to inquire about whether a discount is available for

physicians’ services provided by the non-Stanford physician; such physicians are not

covered by this Policy.) In the event that there is uncertainty as to whether a particular

service is medically necessary, a determination shall be made by the Chief Quality

Officer of SHC. Except as specifically stated, reference to “healthcare services” or

“hospital services” shall mean such medically necessary physician services provided by

Stanford Physicians.

b. Services that are generally not considered to be medically necessary and are therefore not

eligible for the Uninsured Patient Discount include:

1) Reproductive Endocrinology and Infertility services

2) Cosmetic or plastic surgery services

3) Vision correction services including LASEK, PRK, Conductive Keratoplasty,

Intac’s corneal ring segments, Custom contoured C-CAP, and Intraocular contact

lens

4) Hearing aid and listening assistive devices

In rare situations where a SHC physician considers one of these services to be medically

necessary, such services may be eligible for the Uninsured Patient Discount upon review

and approval by the Chief Medical Officer of SHC. SHC reserves the right to change the

list of services deemed to be not medically necessary at its discretion.

c. Second opinions are not considered to be medically necessary hospital or physician

services and are therefore not eligible for the Uninsured Patient Discount.

3. Uninsured Patient Eligibility Requirements:

Last Approved Date: 09/13/2019

Policy Title: Uninsured/Under-insured Patient Discount Policy

(Non-Emergency Services)

Page 3 of 7

Departments: All Departments

Key Words: Discount, uninsured, patient

discount

Reference # NA

a. SHC shall provide the Uninsured Patient Discount to those individuals who meet the

definition of an Uninsured Patient as set forth below and who attest to their eligibility.

b. An Uninsured Patient for the purposes of this Policy is an individual who meets the

criteria set forth in both (1) and (2):

(1) The term “patient” shall also mean the patient’s “family.” A patient’s “family” means:

i. For an individual 18 years of age and older, that individual’s spouse, domestic

partner and dependent children under 26 years of age, whether living at home

or not.

ii. For an individual under18 years of age, that individual’s parent, caretaker,

relatives and other children of the parent, caretaker or relative who are under

26 years.

(2) The patient is “self-pay” and therefore deemed to be “uninsured” for the purposes of

this Policy if any of the following apply:

i. The patient does not have third-party coverage from a health insurer, health

care service plan, Medicare, or Medi-Cal, and does not have an injury that is

compensable for the purposes of workers’ compensation, automobile

insurance, or other insurance as determined and documented by SHC.

ii. The patient has third-party coverage, but the patient has exceeded the benefit

cap for such coverage prior to admission to SHC.

iii. The patient has third-party coverage but the third- party payer has either

denied coverage or does not provide coverage for the particular healthcare

services for which the patient is seeking treatment from SHC.

iv. The patient is not covered by Medicare, Medicaid or any other governmental

program and has third-party out-of-network coverage with no or limited out-

of-network benefits for non-emergency services.

4. Information To Be Provided By Patient For Eligibility Determination:

a. SHC shall determine eligibility for the Uninsured Patient Discount in accordance with

this Policy, and shall not take into account an individual’s age, gender, race, immigrant

status, sexual orientation or religious affiliation.

Last Approved Date: 09/13/2019

Policy Title: Uninsured/Under-insured Patient Discount Policy

(Non-Emergency Services)

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Departments: All Departments

Key Words: Discount, uninsured, patient

discount

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b. A patient who has third-party coverage and is applying for the Uninsured Patient

Discount shall provide information regarding such coverage as requested by SHC so that

the hospital can make an independent determination whether the patient is an Uninsured

Patient as set forth above.

c. SHC expects a patient to cooperate fully in the information gathering process under this

Policy, and failure to do so many affect the hospital’s ability to provide the Uninsured

Patient Discount.

B. PUBLIC NOTICE

1. Public notice concerning the availability of Uninsured Discounts under this Policy shall be by

the following means:

a. Posted notices explain that SHC has a variety of options available including discounts and

financial assistance to patients who are uninsured or underinsured.

b. Notices include a contact telephone number a patient can call to obtain more information

about such discounts and financial assistance.

2. SHC billing statements inform the patient that Uninsured Discounts are available by

contacting the SHC Customer Service Center.

IV. COMPLIANCE

A. All workforce members including employees, contracted staff, students, volunteers, credentialed

medical staff, and individuals representing or engaging in the practice at SHC are responsible for

ensuring that individuals comply with this policy;

B. Violations of this policy will be reported to the Department Manager and any other appropriate

Department as determined by the Department Manager or in accordance with hospital policy.

Violations will be investigated to determine the nature, extent, and potential risk to the hospital.

Workforce members who violate this policy will be subject to the appropriate disciplinary action

up to and including termination.

Last Approved Date: 09/13/2019

Policy Title: Uninsured/Under-insured Patient Discount Policy

(Non-Emergency Services)

Page 5 of 7

Departments: All Departments

Key Words: Discount, uninsured, patient

discount

Reference # NA

V. APPENDICES

A. Attachment A: Current Uninsured Discount Rate Information

VI. RELATED DOCUMENTS

A. SHC Financial Assistance / Charity Care Policy

B. SHC Debt Collection Policy

VII. DOCUMENT INFORMATION

A. Legal Authority/References

None

B. Author/Original Date

June 2007, David Haray, Vice President, Patient Financial Services

C. Gatekeeper of Original Document

Director, Patient Financial Services - Self-Pay Management Office

D. Review and Renewal Requirements

This Policy will be reviewed semi-annually or as required by change of law or

practice. Any changes to the Policy must be approved by the same entities or persons

who provided initial approval.

E. Review and Revision History

− June, 2007, Sarah DiBoise, Chief Hospital Counsel, Gary May, VP Managed Care, SUMC,

David Haray, VP Patient Financial Services, SUMC

− November, 2007, Sarah DiBoise, Chief Hospital Counsel, Gary May, VP Managed Care,

SUMC, David Haray, VP Patient Financial Services, SUMC

− September 2010, Steve Chinn, DPM, Director, Accreditation, Quality & Safety

− March, 2014, Sarah DiBoise, Chief Hospital Counsel, David Haray, VP Patient Financial

Services

Last Approved Date: 09/13/2019

Policy Title: Uninsured/Under-insured Patient Discount Policy

(Non-Emergency Services)

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Departments: All Departments

Key Words: Discount, uninsured, patient

discount

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− December, 2014 Andrea M. Fish, Office of General Counsel, Terri Meier, Director

Patient Financial Services, Michael Honeyman, Assistant Director Patient

Financial Services

− July, 2018, Andrea M. Fish, Office of General Counsel, Kristine Grajo, Director

Patient Financial Services – Self-Pay Management Office

− June, 2019, Sarah J. Diboise, Office of General Counsel, Noel Juaire, Interim

Executive Director Patient Financial Services, Kristine Grajo, Director Patient

Financial Services – Self-Pay Management Office

F. Approvals

− August 2007, SHC Core Operations Group

− February 2008, SHC Core Operations Group

− October 2010, Quality, Patient Safety & Effectiveness Committee

− November 2010, SHC MEC

− November 2010, SHC Board Credentials, Policies and Procedures Committee

− May 2014, Quality, Patient Safety and Effectiveness Committee

− June 2014, Medical Executive Committee

− June 2014, Credentials, Policies & Procedures Committee

− August 2015, Credentials, Policies & Procedures Committee

Last Approved Date: 09/13/2019

Policy Title: Uninsured/Under-insured Patient Discount Policy

(Non-Emergency Services)

Page 7 of 7

Departments: All Departments

Key Words: Discount, uninsured, patient

discount

Reference # NA

Attachment A

Current Uninsured Discount Rate Information

As of March 28, 2019

Pursuant to this Policy, individuals identified as Uninsured Patients may receive the following discounts for

services qualifying as medically necessary. Discounts for 340B drugs are only for 340B eligible patients and

are not applicable to this policy.

 A fifty percent (50%) discount for Physician Fees of Stanford University employed faculty (Stanford)

physicians.

 A sixty percent (60%) discount for Hospital Fees charged by Stanford Health Care (SHC) for domestic

patients.

 A fifty percent (50%) discount for Hospital Fees charged by Stanford Health Care (SHC) for

international medicine patients.

Additionally, the cost of select outpatient drugs, device and supplies will be charged to the Uninsured Patient at

SHC’s cost plus five percent (5%) for Hospital Fees.

Additional discounting for Stanford Physicians will be applied to the following Physician Fees Only:

 Multiple surgery: fifty percent (50%) discount for second procedure, seventy five percent (75%)

discount for third procedure and any additional procedure

 Assistant surgeon: seventy five percent (75%) discount

 Co-surgeon: thirty three percent (33%) discount

 Bi-lateral procedure: thirty three percent (33%) discount

 Psychiatry: sixty percent (60%) discount

This additional discounting for the Stanford Physician services listed above shall apply to the Uninsured Patient

Discount. Such additional discounts will be taken first from billed charges. The Uninsured patient discount of

fifty percent (50%) will be applied to the balance as applicable pursuant to the Policy.

The current discount amounts are reviewed on a quarterly basis and are subject to change at any time without

notice.