Here are answers to frequently asked questions about healthcare services and patient eligiblity in the Hospital Uninsured Patient Discount Act.
Does the law require hospitals to provide non-emergency or elective services to patients?
No. While a hospital’s obligation to treat emergency medical conditions under EMTALA is unaffected, this law does not expand in any way a hospital’s responsibility to treat a particular patient or a particular condition. Section 20 states:
“Nothing in this Act shall be construed to require a hospital to provide an uninsured patient with a particular type of health care service or other service.”
Does the discount apply to cosmetic surgeries or social and vocational services?
No. The discount only applies to medically necessary service that would be covered by Medicare for a patient with the same clinical presentation.
Does the discount apply to outpatient procedures?
Yes, but the discount is applied only for charges over and above $300 in any one encounter.
Does the discount apply to hospital-based physician charges?
No. The Act applies only to hospital services.
Who is an “uninsured” patient?
An uninsured patient is an Illinois resident who is not covered under any third-party coverage of any kind, including high-deductible plans, workers’ compensation, accident liability insurance or other third-party liability.
If a patient has insurance but the service he or she received is not covered, does the discount still apply?
No. The discount only applies to an uninsured patient who is not a beneficiary under any type of plan. Patients that are insured but not covered for a particular service are still defined as being insured.
What type of documentation is needed to determine income eligibility?
Hospitals may require documentation of family income from an uninsured patient requesting a discount. Acceptable documentation includes any one of the following:
- Copy of the most recent tax return;
- Copy of the most recent W-2 form and 1099 forms;
- Copies of the two most recent pay stubs;
- Written income verification from an employer if paid in cash; or
- One other reasonable form of third-party income verification deemed acceptable to the hospital.
How does a hospital determine if a patient is an Illinois resident?
A hospital may ask for one of the following:
- Any document listed above for determination of income;
- Valid state-issued ID;
- Recent residential utility bill;
- Lease agreement;
- Vehicle registration card;
- Voter registration card;
- Mail addressed to the uninsured patient at an Illinois address from a government or other credible source;
- Statement from a family member of the uninsured patient who resides at the same address and presents verification of residency; or
- Letter from a homeless shelter, transitional house or other similar facility verifying that the uninsured patient resides at the facility.
What information is needed to verify assets for eligibility for the 25% cap?
Hospitals may require an uninsured patient to certify to the existence of assets owned and the value of such assets. Acceptable documentation may include statements from financial institutions or some other third-party verification of an asset’s value. If no third-party verification exists, then the patient shall certify as to the estimated value of the asset.
What impact would this legislation have on the immigrant population?
This bill does not change the immigrant population’s current ability to access care. As long as they can verify Illinois residency and meet the income and medical necessity criteria, they are eligible for the discount. Hospitals are free to provide this discount to anyone, but are only required to provide it to uninsured Illinois residents with incomes at or below 600% FPL/300% FPL.