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Charity Care Policy


To outline the Blount Memorial Hospital policy and procedure for the identification of charity care accounts and financial assistance to low-income uninsured/underinsured patients by providing guidance to hospital personnel in determining eligibility.           


Charity care shall be defined as care rendered to patients who are unable to pay and have exhausted all sources of payment assistance for services rendered, as opposed to bad debt, which is defined as services rendered to patients who are unwilling to pay, or financial assistance which balances a patient’s need for financial assistance with the hospital’s fiscal responsibilities. 
All services shall be eligible for charity with the following exceptions:

  • That portion of services currently covered by other programs or reimbursement is anticipated from any source.
  • Those services otherwise covered by insurance (Medicare, Medicaid, Tenncare, BCBS, etc.) had the individual followed the requirements of their policy.
  • Services that are not medically necessary and/or not covered by third party insurers (e.g. solely cosmetic surgery, teeth extractions in an outpatient setting, bariatric surgery etc).
  • Patients with a primary residence outside of Tennessee and the county of Blount; consideration will be given to residents of Monroe, Loudon and Sevier counties.  All exceptions will be considered on a case-by-case basis.
  • Patients who are temporarily unable to work due to illness or injury and their earning potential is expected to exceed the income guidelines of this policy within 24 months.


Patients requiring emergent or urgent medical care will not be refused service based on their ability to pay.  Possible payment alternatives will occur after medical care and treatment have been rendered. 

Financial assistance provided by the hospital is not a substitute for personal responsibility.  All patients are expected to contribute to the cost of their care, based upon their individual ability to pay.

The level of charity care or financial assistance will be based upon the patient’s:

  • household income
  • family size
  • property and financial assets
  • resources for payment or to contribute to the cost of their care

Eligibility for Assessment:

If one or more of the following criteria is met, an unpaid account balance will be considered for write-off as charity care or adjustment based on demonstrated need for financial assistance:

  • Medicaid/TennCare charges which are uncompensated because the patient’s benefits for the year have been exhausted.  A processed remittance voucher must substantiate the denial.
  • Medicaid balances for which the patient is verified to have out of state Medicaid eligibility, and for which Blount Memorial Hospital does not hold a provider number for billing.  A Confidential Financial Evaluation application will not be required.
  • Medicare deductible and/or coinsurance balances with Medicaid QMB eligibility that are uncompensated. A processed remittance voucher must substantiate the unpaid amount.
  • Medicare deductible and/or coinsurance balances for which collection efforts have been exhausted as substantiated by the close and return of the agency placement.
  • Medicare deductible and coinsurance balances for nursing home residents who are eligible for Medicaid nursing home benefits, and have no personal representative handling their finances. Verification of benefit coverage must substantiate eligibility for charity care.
  • Patient balances for services rendered prior to approval of Medicaid/TennCare coverage.  The patient balance is included in income eligibility based on medical expenses. Documentation of benefit coverage must substantiate eligibility for charity care.
  • Patient balances for dates of service when eligibility for the SLMB program has been established.  Verification of benefit eligibility does substantiate eligibility for charity care per Federal Poverty Guidelines as published annually in the Federal Register.
  • Patient balances for the deceased with no estate on file and no known assets.  Documentation of telephone inquiry regarding the probate of estate is required.
  • Patient balances incurred prior to incarceration or admission to a long-term care facility for behavioral health treatment.  Documentation of telephone response to inquiry regarding date of incarceration or admission and expected date of release is required.
  • Patient balance for which the family income as applicable does not exceed 200% of the current Federal Poverty Guidelines as published annually in the Federal Register.

Income Limitations:

The method of determining income shall include, but is not limited to gross income plus nontaxable retirement income (i.e. Social Security), child support, unemployment compensation as well as any payments received for living expenses and "in-kind" payments (i.e. use of property rent free).  The value of food stamps and housing subsidies will be excluded from "in-kind" payment consideration. 

Application for charity care must include verification of income and the value of assets.  Verification may be obtained from one or more of the following forms of documentation:

  • A copy of the previous year’s IRS 1040 forms(s) prepared for the household.  If self employed, a copy of the completed Schedule A—Itemized Deductions and Schedule C—Profit or Loss from Business, is also required.
  • A copy of the most recent pay stub with year to date earnings for the patient or guarantor and spouse.
  • A copy of the most current quarterly IRS 1040 forms reporting income from self-employment.
  • A copy of the most recent bank statement for the household.
  • A copy of forms approving or denying unemployment or worker’s compensation.
  • A copy of monthly pensions or income from retirement plans.
  • Written verification of earnings from employer or company accountant.
  • Written verification from public welfare agencies or any other governmental agency, which can attest to the patient’s income status for the past twelve months.
  • A notarized statement from a parent, relative or household resident concerning current employment and income status for the patient or guarantor.
  • Copies of monthly prescription costs and medical bills owed to other providers as well as a copy of the payment arrangements to settle these accounts.

A Confidential Financial Evaluation application will not be required for the following:

  • Chart documentation from clinical staff and/or case managers that the patient is homeless and has no known assets.
  • On-line eligibility verification of a Medicaid/TennCare recipient who qualifies as indigent based on income.
  • Documented telephone verification for out of state Medicaid benefits with verification source noted.
  • Documented telephone verification of probate of estate for deceased patients.
  • Documented telephone verification of incarceration and/or internet verification of facility assignment.
  • Documented telephone verification of admission to a long-term care facility for behavioral health .

Asset Limitations:

The guidelines for determining assets include, but are not limited to, savings, retirement fund, investments, farm land, business property, rental property, farm and/or business equipment including livestock and crops, other items that can be sold for cash including motor vehicles and land.


For catastrophic illness, exceptions to income and asset limitations may be made on a case-by-case basis.


Patient and/or their guarantor may be screened for potential charity care eligibility if they are:

  • unable to pay
  • will not return to or begin employment within 24 months, and
  • have exhausted all sources of payment assistance

The patient/guarantor must:

  • complete a Confidential Financial Evaluation form,
  • provide full disclosure of personal income, expenses and assets, and
  • provide additional documentation as requested

Based on policy income and asset limitations, the patient/guarantor’s financial disclosure and requested documents will be screened to determine eligibility for:

  • financial assistance, or
  • charity care

Pertinent data will be scanned into the patient’s financial folder once a request for charity care has been documented, applicable verification of income and assets secured and eligibility determined.  Authorized account balance adjustments or write-off will be completed.

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