This is an application for financial assistance (also known as charity care) at Teton Valley Health Care.
TVHC provides financial assistance to people and families who meet certain income requirements. You may qualify for free care or reduced-price care based on your family size and income, even if you have health insurance.
We want to help. Please submit your application promptly!
You may receive bills until we receive your information.
Financial assistance plain-language summary
Teton Valley Health Care (TVHC) cares for you and your healthcare needs regardless of your ability to pay. We are committed to working with you, on your financial needs related to your care. This includes, finding ways to make your care more affordable. TVHC offers financial assistance to our eligible patients who do not have the financial means to pay for their healthcare expenses. If you are having trouble paying for all or some of your health care expenses at one of our TVHC facilities, we encourage you to talk with a Patient Account Representative about options to help you with these expenses.
What is Covered
We provide financial assistance to eligible patients on a sliding fee scale for medically necessary services. Our discounts range from 15% to 100% based on the Federal Poverty Guidelines.
How to Apply
A patient seeking financial assistance must provide supporting documentation outlined in the “financial assistance application,” form unless TVHC indicates otherwise. The application form may be obtained as follows; online through our website, by calling the number below, or by visiting our hospital or clinics.
- Phone – (208) 354-2383
- Hospital FAP APPLICATION FORM (English) – 2024
- Hospital FAP APPLICATION FORM (Spanish) – 2024
Other Assistance
If you are without healthcare insurance, you may be eligible for other government and community programs. We can help you research and apply for other programs that may be available to you. Other programs may include: Medicare, Medicaid or Veterans Affair.
Limitations on Charges
TVHC uses the “Amounts Generally Billed” (AGB) formula to determine the discount amounts that will be offered to uninsured patients, who otherwise do not qualify for financial assistance. The AGB is determined by looking at all billed and paid claims from the prior year. The net payment amount is used to determine the average payment amount per financial class. The intent is to not charge our self-pay patients more than we expect an insurance company to pay. This discount (501r) applies to emergent and medically necessary services for all Teton Valley Health Clinics and Teton Valley Hospital services. The AGB calculation is used to determine the discount for the following calendar year
Payments
After your insurance company processes your claim, any balance for amounts owed by you, is due within thirty days, unless other arrangements have been made. We accept; cash, check, online bill-pay, or credit cards. If you would like to establish a payment plan, please call the number listed below. Balances not paid, may be assigned to an outside collection agency and are subject additional fines, penalties and fees. If you would like a copy of our collection policy, please call patient accounts at (208) 354-2383.
Emergency Care
TVHC has a dedicated emergency department that provides care for emergency medical conditions (as defined by the Emergency Medical Treatment and Labor Act) without discrimination, regardless of your ability to pay for services.
List of Providers/Entities Covered
Per Reg. Sec. 1.504(r)-4(b)(1)(iii)(F) and Notice 2015-46, this list specifies which providers of emergency and medically necessary care delivered in the hospital facility are covered and not covered. Elective procedures and other care that is not emergency care or otherwise medically necessary are not covered by the FAP for any provider.
All Teton Valley providers (physicians, physician assistance, nurse practitioners and licensed clinical Social workers.
- TVHC Anesthesiologist/CRNA’s
- TVHC Emergency Room providers
- TVHC Surgery providers
- TVHC Method II providers
- TVHC Physical Therapist, Occupational Therapist and Speech Therapy
- TVHC Locum Tenens
- TVHC Contract Providers
- TVHC Respiratory Therapist
- All TVHC Clinics; Specialty Clinic, Driggs Health Clinic, and Victor Health Clinic
List of Providers/Entities Not Covered
Per Reg. Sec. 1.504(r)-4(b)(1)(iii)(F) and Notice 2015-46, this list specifies which providers of emergency and medically necessary care delivered in the hospital facility are covered and not covered. Elective procedures and other care that is not emergency care or otherwise medically necessary are not covered by the FAP for any provider.
- Bio Tel Heart – Holter Monitor
- Medical Imaging Associates
- Kinghorn Medical LLC (Mountain Brace Systems)
For more information about getting help with your Teton Valley Health Care, medical bills, please call or visit a financial counselor or billing office at TVHC. We can give you any forms you need and can help you apply for assistance. Patients are strongly encouraged to ask for financial help before receiving medical treatment, if possible. Patients can also apply at any time while receiving treatment and for a period of time following receipt of your initial bill. 208-354-6323, ext. 461
Definitions
Charity Care/Financial Assistance
Medically Necessary and/or Emergency Care services provided for free or at a reduced price for patients who have no or limited income and who would otherwise be unable to pay for their treatment. Charity Care is also referred to as uncompensated care and financial assistance.
Indigent Care
Under 42 CFR Section 413.89, Medicare is to reimburse deductible and coinsurance amounts for Medicare beneficiaries that remain unpaid after the provider has made a reasonable effort to collect. The provision is to assure that the covered costs of Medicare beneficiaries is paid. If the patient is presumed indigent, the provider must bill Medicaid (if eligible) before any unpaid deductible or coinsurance can be claimed. In addition, if no other coverage, and limited income, the patient may also qualify for indigent care. Debts are adjusted as Medicare bad debt and are not considered a contractual adjustment.
501(r) IRS Regulation
The Affordable Care Act imposes four requirements on non-profit hospitals and health systems in order to maintain their tax-exempt, non-profit status. Three of these requirements relate directly to the revenue cycle operations including a Financial Assistance policy (FAP), set charge limits (AGB) for FAP eligible patients and make reasonable efforts to determine FAP eligibility before engaging in extraordinary collection activity against an individual.