Financial assistance program

Financial assistance program purpose

Rogers’ Financial Assistance Program helps people who are unable to pay for emergency and medically necessary services they receive.  For eligible patients/guarantors, Rogers may reduce bills in part or in full.

Financial assistance from Rogers comes with two expectations. Patients are expected to cooperate with Rogers’ procedures for obtaining other forms of payment or financial assistance and to contribute to the cost of their care based on their individual ability to pay.

Emergency services

Rogers Behavioral Health System, Inc. will provide, without discrimination, care for emergency mental health conditions to individuals regardless of their eligibility for financial assistance or for government assistance.  Rogers Behavioral Health System’s policy is to provide emergency behavioral healthcare to stabilize patients, regardless of their ability to pay. Rogers’ staff are prohibited from engaging in actions that discourage individuals from seeking emergency medical care, such as demanding that emergency patients pay before receiving treatment or permitting debt collection activities in areas of the hospital where such activities could interfere with the provision, without discrimination, of emergency medical care. Following medical evaluation, non-emergent patients in inpatient and residential treatment requiring financial assistance consideration will be reviewed and approved before additional services are provided.

Eligibility criteria for financial assistance

Eligibility criteria for financial assistance are:

• Patient is an established Rogers patient

• Patient is uninsured, the care provided is not covered by insurance plan, or the patient has a high deductible and/or coinsurance.

• Household income is 100% - 400% of the Federal Poverty Guidelines

Financial assistance for qualified individuals and families will be calculated as a percentage of total eligible charges according to the following schedule:

Percentage of Federal Poverty Guidelines	Percentage of Financial Assistance
100%	100%
125%	87%
150%	75%
175%	60%
200%	50%
225%	44%
250%	38%
275%	32%
300%	25%
325%	19%
350%	13%
375%	7%
400%	0%

Patients eligible for financial assistance will not be charged individually more than the amount generally billed (the “AGB”) to individuals who have insurance covering such care.  In the event of nonpayment of balances due, Rogers may take extraordinary collection actions (ECA) and refer the balance to a collection agency. 

Limitations

Rogers’ financial assistance does not include all costs that may be associated with behavioral health services. Items or services that are not included in our financial assistance program include, but are not limited to, transportation, lodging, prescriptions, food, medical equipment, lab services, and pharmacy supplies.

Applications may be submitted any time after admission but can only be processed after the patient is discharged and any insurance or other payer has completed processing of the claim and the payments or denials have been posted to the accounts. Applications must be received within 240 days of the first patient statement and may need to be renewed for each admission or every 240 days.

Method of applying for financial assistance

Patients who want to apply for financial assistance, or who have been identified as a potentially eligible for financial assistance, will be informed of the application process. The application process may be waived or suspended due to medical necessity, including timing and urgency of care. Patients or their representative can obtain a financial assistance application at no charge by mail by contacting Patient Financial Services at 833-608-2410 or at Rogers locations including 34700 Valley Road Oconomowoc, WI 53066 or by downloading and printing the financial assistance application here.

All patients/guarantors who receive a financial assistance application must complete and return the application, along with the following documents that serve as the minimum information necessary to process an application for financial assistance:

• Completed financial assistance application;

• Proof of household income (pay stubs for the past 90 days);

• A copy of the three most recent bank statements from all banking or credit union institutions of the household;

• A copy of the two most recent tax returns, including all schedules of patient, spouse, or any person who claims the patient as a tax dependent or an IRS Verification of Non-filing Letter; and

• Full disclosure of claims and/or income from personal injury and/or accident related claims.

• Verification of loss of income, if applicable

Once the application has been submitted, a Patient Financial Services representative will review the application. A patient’s application will be deemed complete after Rogers receives the financial assistance application with all information and the required documentation. Rogers reserves the right to request additional documentation before finalizing a request for assistance. You can find Rogers’ complete financial assistance policy here.

These financial assistance guidelines apply to care at any Rogers location including hospitals and residential facilities in Wisconsin and outpatient care clinics across the nation.