McLean Hospital is dedicated to improving the lives of people and families affected by psychiatric illness. McLean pursues this mission by:
- Providing the highest quality compassionate, specialized and effective clinical care, in partnership with those whom we serve.
- Conducting state-of-the-art scientific investigation to maximize discovery and accelerate translation of findings towards achieving prevention and cures.
- Training the next generation of leaders in psychiatry, mental health and neuroscience.
- Providing public education to facilitate enlightened policy and eliminate stigma.
McLean Hospital, a not-for-profit hospital, is committed to providing quality care to patients in need of psychiatric services. This policy is designed to assist patients based upon a demonstrated financial need.
To that end our facility offers financial assistance in the form of reduced rates to qualified individuals receiving services from financial assistance qualified programs. More information on qualified financial assistance programs can be obtained from our business office at 617.855.3316.
Uninsured and Underinsured Patients
This policy is intended to apply primarily to patients that do not have health insurance from either a public (e.g., Medicaid, Medicare) or a private (e.g., Tufts, Harvard Pilgrim, Blue Cross, etc.) source. Included are:
- Patients with no health insurance.
- Patients whose only “insurance” is the Massachusetts Health Care Safety Net.
- Patients whose balance results from having “exhausted” benefits under their insurance plan.
- Patients whose balance results from “non-covered” services where insurance has determined that the patient is fully responsible for the charges associated with certain excluded services. This includes services where the insurer denied coverage due to the insurer’s limitations. (e.g., out of network and Medicare cap).
This policy excludes co-payments, deductibles, and co-insurance.
This program is limited to patients with demonstrated financial hardship either due to limited income or in cases where their medical bills are a significant portion of their income. The most recently published Federal Income Poverty Guide (FPG) will be used as the primary determinant. A combination of income and available assets will be used to determine the appropriate discount available. In all cases, the total income of the family will be used in this determination. Discounts are generally limited to patients with family incomes of less than 301% of the FPG.
Financial Assistance Due to Excessive Medical Bills
Patients with family incomes of more than 300% of the FGP or non-US residents for whom the FPG is not a useful measure, who can demonstrate that their medical expenses exceed an established percentage of their family income, will be offered a financial hardship discount applicable to all emergent care and associated medically necessary follow-up services. Expenses must have occurred within the prior 12 months and are limited to those expenses that could potentially qualify as a medical expense per the US IRS. Patients wishing to be considered for discounts under this policy must provide requested documentation of income, residence and qualifying medical expenses in a timely manner.
Medicare Bad Debt
This policy may also be used to verify the indigence of a patient for the purposes of qualifying their balances resulting from a co-insurance or deductible from services covered by Medicare. The determinants will be the patient’s current income and their reported asset levels. To qualify, the patient must have an Income of less than 201% of the FPG and assets of less than $8,000 for the first family member with an additional $2,500 for each additional family member. Asset determinations will never include the primary residence or the primary automobile. Application for financial assistance will be proof that the patient has an inability to use assets to pay their outstanding balances.
The patient has a number of responsibilities to meet in order to qualify for this discount program, including:
- Obtaining insurance coverage if affordable coverage is available to them.
- Applying for any government sponsored insurance programs that they may qualify for.
- Submitting all requested documentation of income, assets and residency that is needed to verify their qualifications for any financial assistance in a timely manner.
- Keeping McLean Hospital appraised of current demographic and insurance information.
- Paying all balances in accordance with the agreed to time frames.
Payment Requirement & Payment Plans
Discounts approved under this policy will be applied when a patient is deemed qualified. Payment plans will be offered to patients according to existing guidelines in the McLean Hospital Credit & Collection Policy.
Discounts under this policy do not apply to fixed fee services or services where other discounts (prompt pay) have already been included in the charge, services including The Pavilion, The Appleton Residence at McLean, The Gunderson Residence, The McLean Center at Fernside, The McLean Residence at Lincoln, and 3East. Discounts may not be available to patients in cases where the need for the care was anticipated by the patient and the patient came to McLean Hospital from outside our service area to receive this care. Co-Insurance, deductibles and co-payments are also generally excluded except where specifically noted.
Massachusetts Mandated Insurance
Massachusetts residents earning less than 301% of the Federal Poverty Income Guide (FPIG), generally qualify for some level of coverage either under an insurance program from Mass Health or a subsidized insurance program through Commonwealth Care or other similar programs. These programs provide comprehensive coverage for both hospital and physician bills. This policy assumes that patients who qualify for these programs will apply for and maintain their coverage.
Massachusetts Residents with No Health Coverage
Uninsured Massachusetts residents with no coverage or designation through Health Safety Net will generally be treated as Uninsured Patients and will be provided access to the 25% discount available to all Uninsured Patients for timely resolution of balances as applicable. They will typically not qualify for any other charity discount. These patients will be strongly encouraged to comply with the requirements of Health Care Reform and will be provided with assistance in seeking coverage through all the possible resources including Mass Health, HSN, Commonwealth Care or Commonwealth Choice.
Financial Assistance Discount for Patients with Limited Income
Patients are responsible for full payment of any co-payments, deductibles, or co-insurance amounts that may be due from the covered portion of the stay. Discounts off charges are available based on Available Family Resources as follows. “Available Family Resources” is calculated as the sum of family income from all sources. “Available assets” includes bank accounts, trust funds and investments, excluding pension and retirement accounts; the value of vehicles, excluding up to two personal vehicles; and the value of owned real estate, less any outstanding mortgage, and excluding the patient’s primary residence.
|Available Family Resources
as a Percent of
Federal Poverty Income Guidelines
|Discount Off Charges|
|Up to and including 200%||100%|
|201% - 300%||80%|
|301% - 400%||60%|
Generally, income determination is made based on submission of a copy of the most recent applicable tax return(s) and/or three (3) most recent pay stubs. Other relevant documents may include those related to income received from Social Security, Unemployment Compensation, and other forms of income. Assets may be documented by various means, including account statements, auto blue book schedules, etc. Any omissions or material misstatements of fact will void any discount provided under this policy.
Financial Assistance due to Excessive Medical Bills
Patients who qualify for this discount will have their charges applicable services discounted according to the following schedule. The discounts are based on the total charges and are not applied to balances that have already been discounted due to insurance coverage.
|Family Incomes % of FPG||With Medical Bills
exceeding this percentage
of the Family Income
|301 - 600%||30%||70%|
Patients are encouraged to bring unusual hardships in their financial situations to the attention of Patient Financial Services and/or the McLean Patient Accounting Department. The hospital may extend discounts beyond the other provisions in this policy on a case-by-case basis to recognize documented, unusual cases of financial hardship.