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Financial Assistance Policy

Applying for Financial Assistance

We’re Ready to Help

If you cannot afford to pay your hospital or doctor bill, we are ready to help. UPMC’s Financial Assistance Program may be able to assist with expenses for medical care, including UPMC hospital and physician services.

You can fill out a single UPMC Financial Assistance Application form for any of these services.

If you need the application in a non-English language, you can either:

  • Call 1-800-371-8359 (option 2) to request an application in a specific language.
  • View and download the necessary forms on this page.

If you need the Financial Assistance Application form in a large print version, you can find it on this page as well along with other important financial assistance documents.

Based on your financial need, either reduced payments or free care may be available for these services. UPMC staff will determine if you are eligible for free or discounted health care services by looking at your income and family size. We also may help you set up a payment plan for your UPMC bills. This allows you to make payments within your means.

Please contact UPMC if you require assistance completing the Medical Assistance or Financial Assistance form. Our financial specialists are available to assist you with this process.

You may be eligible for some type of insurance benefits (such as worker’s compensation, automobile insurance, and Medical Assistance). You should explore these options before you can receive financial assistance from UPMC. We can help direct you to the appropriate resources.

Applicants for financial assistance are treated with dignity and respect. We respect your privacy, and all of your information will remain confidential. See UPMC’s Notice of Privacy Practices.

How Do I Apply?

UPMC encourages patients to apply for financial assistance if they believe that they are unable to pay all or part of their UPMC bill.

To Apply:
  1. Complete the UPMC Financial Assistance Application form (formulario de Solicitud de Asistencia Financiera).
  2. Attach supporting documents, listed on the application, to prove your income.
  3. Mail your completed application and necessary documents to:
    UPMC Somerset
    Attn: Cashier
    225 S. Center Avenue
    Somerset, PA 15501

When should I Apply?

  • You should apply for financial assistance as early as possible during your medical care. However, you may apply during or after your treatment.
  • You may reapply if your financial situation changes.

How do I check the status of an application?

Call 814-443-5002 to check on the status of your application. Please allow 2 to 3 weeks for processing and mailing time.

How do I know if I’m approved?

You will receive written confirmation in the mail.

Where can I learn more?

You can get more information about UPMC’s Financial Assistance Program in several ways:

  • At the hospital or physician’s office: Request a Financial Assistance Application form from your case manager, at the front desk in the hospital’s registration area, or at your doctor’s office.
  • By phone: Talk with a financial specialist or request a Financial Assistance Application form by calling UPMC Somerset Financial Assistance Department at 814-443-5002.
  • By appointment: If you need assistance with completing the application form and would like to schedule an appointment, please call our office at 814-443-5002.

Determination of Assistance Amount

In determining a reasonable and fair level of assistance, UPMC applies a sliding scale.

If a patient’s income is below 400 percent of the federal poverty guidelines, the patient may receive some form of Financial Assistance.

If a patient’s income is at or below 300 percent of the federal poverty guidelines:

  • The patient is eligible for 100 percent financial assistance.
  • The fees for UPMC services are completely waived.

If a patient’s income is between 301 and 400 percent of the federal poverty guidelines and they are uninsured:

  • The patient responsibility will be reduced to the current amount generally billed (AGB)

UPMC will not charge an eligible individual for emergency or other medically necessary services more than the amount generally billed (AGB) to individuals who have insurance covering such care.

In some cases, UPMC may recognize other financial or medical conditions that warrant Financial Assistance. If a patient’s income falls outside the guidelines listed above, please contact UPMC’s Financial Assistance Department at 8144-443-5002 in order to review the circumstances. In any case, UPMC staff may be able to help establish a payment plan that helps patients pay their balance over time.

Exclusions

While UPMC’s Financial Assistance Program covers most services, there are some exclusions, such as, but not limited to:

  • Cosmetic services
  • Transplant-related services
  • Bariatric-related services
  • Elective reproductive services
  • Acupuncture
  • Private duty nursing
  • Dental services
  • Services deemed noncovered by Medicare
  • Other services, at UPMC’s discretion

Financial Assistance is not typically available for:

  • People who fail to reasonably comply with insurance requirements, such as obtaining authorizations or referrals

In addition, this policy does not apply to international patients who come to Pennsylvania in order to seek treatment from a UPMC provider.

Large Print Financial Documents

Translated Financial Documents


Understanding the Charge Description Master (CDM) File

The CDM file is a hospital’s regularly updated database containing the list of standard charges (i.e. “list prices”) assigned to procedures, services, drugs, and supplies associated with the delivery of medical care at that hospital or facility. Standard charges are standard dollar amount that a UPMC hospital sets for services rendered before negotiating any discounts. It is important to note that the standard charge is not the amount that a patient is expected to pay for receiving health care services. A patient’s financial obligation is determined by many factors, including insurance coverage and benefit plan limits.

Patients seeking an estimate of the out-of-pocket amount that you will be expected to pay for receiving health care services should contact the UPMC Price Estimator team at 1-800-371-8359, option 5. If you need help for paying your health care costs, please see the Financial Services web page for more information on financial assistance, screening for medical assistance, and payment plans.

Please see the Frequently Asked Questions section below for more information on the Charge Description Master (CDM) file.

Charge Description Master (CDM) File

The UPMC Somerset CDM file is downloadable is MS Excel format. Per regulations issued from the Centers for Medicare and Medicaid Services, this file will be updated at least annually.

Each row of the CDM file contains information regarding a certain medical service, surgical procedure, supply item, or drug. The first column of each row contains the name of the hospital, the second column of each row contains the description of the medical service, surgical procedure, supply item, or drug, and the third column of each row contains the standard base charge for that item.

Patients seeking to understand their out-of-pocket costs, see the Financial Services We Offer web page for information on price estimates, financial assistance, and payment plans.

CDM Frequently Asked Questions (FAQ’s)

What is the Charge Description Master (CDM)?

The Charge Description Master (CDM) file is a hospital’s regularly updated database containing the list of Standard Charges assigned to procedures, services, drugs, and supplies associated with the delivery of medical care at that hospital or facility

What is a “Standard Charge”? 

The standard dollar amount a UPMC provider sets for services rendered before negotiating any discounts. The charge can be – and often is – different from the amount paid.

How are “standard charge” amounts established? 

Standard charges are reflective of the clinical services directly involved in your care (e.g. nurses, technicians, and other staff providing care), as well as the drugs and supplies used to provide care. Standard charges also reflect support areas not directly related to your care such as housekeeping, facilities maintenance, information technology, medical records, etc.

Additionally, hospital charges allow for future investments in cutting-edge diagnostic and therapeutic services, improvements to hospital facilities, and the expansion of clinical programs & services that are needed to provide world-class medical care.

Are standard charges different based on my insurance? 

No, the standard charge amount assigned in the CDM is the same regardless of type of insurance or payer coverage. All patients at a hospital receive the same charge amount for the same service.

I have insurance – do standard charges reflect what I will be responsible for paying? 

No, if you have in-network insurance coverage your out-of-pocket payment responsibility is based on the benefits of your insurance plan. Your insurance determines the copay, coinsurance, and deductible amounts that you will be responsible for paying out-of-pocket. Copay, coinsurance, and deductible amounts are determined by your insurance company and are not affected by standard charges.

Similarly, your coinsurance and deductible amounts are determined by the contracted payment rates your insurance company has made with the hospital (called the “allowable”), not on the standard charge in the CDM.

Because your insurance plan benefits determine your out-of-pocket costs and payment for your services is based upon contracted rates, the hospital CDM file of standard charges is not a useful tool for determining the out-of-pocket cost that you will pay for your health care.

How can I determine my out-of-pocket costs? 

If you would like an estimate of how much a procedure will cost before you schedule your appointment, please contact the UPMC Price Estimator team and ask for an estimate for the cost of your planned services.

Please call 1-800-371-8359 option 5 to request a price estimate.

Note that the actual amount of your out-of-pocket costs for UPMC services included in the estimate may be greater or less than the estimate provided to you via the UPMC Price Estimator team for such services or procedures.

I have insurance, but my insurance does not have a contract with UPMC. How can I determine my out-of-pocket costs? 

If you have insurance that is not contracted with UPMC, please contact your insurance company for more information on out-of-network benefits. You can also contact the UPMC Price Estimator team for an estimate of out-of-pocket costs as well.

I do not have insurance – do standard charges reflect what I will be responsible for paying? 

No – standard charges do not reflect your out-of-pocket cost for nearly all hospital clinical services and visit types.

For patients who have no insurance, there are multiple options for providing help for paying your health care costs. Please see UPMC’s Financial Services web page for more information on financial assistance, screening for medical assistance, and payment plans. 

Machine Readable File of Items & Services

Pursuant to the 2020 Hospital Outpatient Prospective Payment System (OPPS) rule issued by Centers for Medicare and Medicaid Services (CMS), UPMC Somerset is providing online access to a Machine-Readable file of Items & Services in CSV format. “Machine-readable” means that the data file can be easily processed by a computer. Consistent with these regulations issued by CMS, this file will be updated at least annually.

For each hospital item or service provided to patients, the Machine Readable File of Items & Services specifies the hospital standard (gross) charge, discounted cash price (for an individual who pays cash), and the minimum and maximum charge that a hospital has negotiated with a third-party payer. Additionally, this file contains payer-specific negotiated charge amounts as required by CMS.

It is important to note that contracts negotiated between hospitals and payers use many different, and frequently unique, reimbursement methodologies. Hospital reimbursements for clinical services, i.e., charges, may be conditionally paid based on other services provided, or bundled into the payment for other services. Reimbursements also may vary due to other negotiated, complex criteria specific to particular payer contracts. Consequently, using the Machine Readable File of Items & Services to conduct comparisons of contracted payment rates for specific line items across payers may not accurately reflect total contracted reimbursement rates.

Download the UPMC Somerset Machine Readable File of Items & Services as of 06/08/21

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