Medically necessary services are those that are absolutely necessary to
treat or diagnose a patient and could adversely affect the patient’s
condition, illness or injury if it were omitted, and is not considered
an elective or cosmetic surgery or treatment.
Charity Care Patient is a patient who is unable (versus unwilling) to pay
for GSH services. In all cases a patient whose Family Income does not
exceed 350% of the federal poverty level (FPL) can be considered under
this policy. Patients from families with high incomes (or undocumented
incomes) may also qualify if Good Samaritan staff reasonably determines
the Patient is unlikely to have the resources to pay for the care.
A Self Pay Patient is a patient who does not have coverage through personal
or group health insurance and is not eligible for benefits through Medicare,
Medi-Cal, the Healthy Families program, California Health Benefit Exchange,
Los Angeles County Indigent Patient Program, California Children’s
Services (CCS), Victim of Crime (VOC), worker’s compensation, State
funded California Healthcare for Indigent Program (CHIP), coverage for
accidents (TPL), or any other program.
A High Medical Cost Patient is a patient who has insurance or is eligible
for payment from another source, but who has family income at or below
350% of the FPL and out-of-pocket medical expenses in the prior twelve
(12) months (whether incurred in or out of any hospital) that exceeds
10% of Family Income.
Family Income would include the income from all members of the patient’s
“family.” For a patient 18 years of age and older, family
includes the patient’s spouse, domestic partner and dependent children
under 21 years of age, whether living at home or not. For a patient under
18 years of age, family includes the patient’s parents, caretaker
relatives and other children under 21 years of age of the parent or caretaker relative.
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