White River Health System (WRHS) is a tax exempt organization committed to providing medical care for residents of North Central Arkansas. We will not refuse medically necessary services to any patient regardless of ability to pay for medical services.
We know most medical costs are unexpected, and understanding your medical bills can be complicated. The WRHS financial team wants to help you meet your treatment needs. Our billing specialists and financial advocates are available to help answer your questions.
WRHS accepts most major insurance plans. If you have any questions about your coverage or its applicability to WRHS services, please contact your company's representatives.
WRHS participates in a large number of commercial plans, PPOs, HMOs, and Workers' Compensation MCOs. We are continually growing and adding other networks to provide regional care to area residents. If you have a question about your coverage, call our Patient Financial Solutions Specialist for assistance at (870)262-1188 or via email at jmartin@wrmc.com.
WRHS will bill your health plan on your behalf, including Medicare and Medicaid, for payment of hospital services. However, it is important to remember that you are ultimately responsible for payment of your hospital bill.
Many insurance companies require proper authorization, pre-certification and/or referrals. It is your responsibility to know what your insurance company requires and to obtain the proper authorization. WRHS may ask you to pay any unmet deductibles, co-payments or other self-pay amounts that are due prior to the time of service or prior to discharge.
If you do not have health insurance or if you are experiencing financial difficulties paying your medical bills or you anticipate that you may not be able to pay your bill, WRHS offers a financial assistance program. Financial Assistance is available for patients with limited incomes and who are uninsured or under-insured. Patients may be eligible to receive financial assistance for non-emergency, medically necessary services at WRHS if they meet the income limits. The WRHS Financial Assistance policy applies to all WRHS facilities and employed providers.
FInancial Assistance ApplicationFinancial Assistance PolicyFinancial Assistance Application - Español
We know most medical costs are unexpected, and understanding your medical bills can be complicated. The White River Health System (WRHS) financial team wants to help you meet your treatment needs. Our billing specialists and financial advocates are available to help answer your questions.
Yes, our online payment service enables you to pay patient bills quickly, securely and conveniently. You can pay all or part of your bill online. There are no fees associated to paying your bill online or on the phone. We accept: Cash, Check, Debit, HSA/FSA, and most major Credit Cards.
When using our online bill pay system:
Yes, if you are unable to make an online payment, you are welcome to use traditional bill payment options via phone or mailing payment to:
PO Box 2197
Batesville, AR 72503
Office Hours: Monday - Friday, 8:00 am – 4:30 pm
Phone: 870-262-3115 or 877-235-9091
We will gladly work with all our patients for a better understanding of their WRHS bill. Please contact us at (870) 262-3115 or (877) 235-9091 for an explanation.
We are also here to provide support and financial assistance if you are having trouble paying your bill. Please call (870) 262-1253 for help. We also offer the options of monthly payment plans and applying for financial assistance based upon family size and income.
Updated April 2020
CPT Code 87635/G2023
Cash Price: $198
To help patients prepare for medical expenses, White River Health System has provided a link to hospital services and applicable standard charges. The charges for your hospital stay and your out-of-pocket costs depend on many factors including, your individual care needs, insurance coverage, deductibles, and co-insurance amounts.
The charges listed do not include professional fees charged by physicians and other health professionals such as the anesthesiologist, emergency room physician, hospitalist, pathologist, and/or radiologist who may provide consultation and care.
White River Health System Patient Financial Advocates are available to assist you in understanding your hospital bill. Additionally White River Health System has financial assistance available for those who qualify. To obtain an estimate of charges and your financial responsibility for an upcoming hospital stay or outpatient procedure, please call 870-262-2929 Monday through Friday from 8 am to 4:30 pm. with your insurance information. Standard hospital charges are published in accordance with regulations established by the Center for Medicare and Medicaid Services and are subject to change without notice.
We know most medical costs are unexpected, and understanding your medical bills can be complicated. The White River Health System (WRHS) financial team wants to help you meet your needs. Our billing specialists and financial advocates are available to help answer your questions.
If paying your bill creates a financial burden or you believe the cost of your healthcare will be a financial burden, it is very important to let us know so we can help.
White River Health System
870-262-1253
If approved, Financial Assistance reduces your WRHS bill. Your financial assistance is only applicable for services received at WRHS facilities and by WRHS providers. How much it is reduced is based on established guidelines that include income level, medical condition, and other indicators of inability to pay. If you think you might qualify for assistance, we encourage you to contact us and apply.
You may be eligible for:
Financial Assistance is available for patients with limited incomes and who are uninsured or underinsured.
Patients may be eligible to receive financial assistance for non-emergency, medically necessary services at WRHS if they meet the income limits.
If your income is equal to or less than 100% of the current Federal Poverty Guidelines and you meet the Financial Assistance Guidelines, you may be eligible for care at no cost to you. If your income is greater than 100% but not greater than 300% and you meet the Financial Assistance Guidelines, then you may be eligible for care at a reduced cost to you.
| Family Size | 100% | 133% | 138% | 150% | 200% | 250% | 300% | 400% |
|---|---|---|---|---|---|---|---|---|
| 1 | $12,140 | $12,140 | $16,753 | $18,210 | $18,210 | $18,210 | $36,420 | $48,560 |
| 2 | $16,460 | $21,892 | $22,715 | $24,690 | $32,920 | $41,150 | $49,380 | $65,840 |
| 3 | $20,780 | $27,637 | $28,676 | $31,170 | $41,560 | $51,950 | $62,340 | $83,120 |
| 4 | $25,100 | $33,383 | $34,638 | $37,650 | $50,200 | $62,750 | $75,300 | $100,400 |
| 5 | $29,420 | $39,129 | $40,600 | $44,130 | $58,840 | $73,550 | $88,260 | $117,680 |
| 6 | $33,740 | $44,874 | $46,561 | $50,610 | $67,480 | $84,350 | $101,220 | $134,960 |
| 7 | $38,060 | $50,620 | $52,523 | $57,090 | $76,120 | $95,150 | $114,180 | $152,240 |
| 8 | $42,380 | $56,365 | $58,484 | $63,570 | $84,760 | $105,950 | $127,140 | $169,520 |
| PATIENT INCOME | DISCOUNT |
|---|---|
| At or Below 150% of the FPG | 100% or Free Care |
| Between 151% and 200% of the FPG | 90% Discount |
| Between 201% and 250% of the FPG | 80% Discount |
| Between 251% and 300% of the FPG | 70% Discount |
| Between 301% and 350% of the FPG | 60% Discount |
| At or Above 351% of the FPG | 0% Discount |
If you cannot pay your bill, payment plans may be arranged with White River Health System. Please contact us at 870-262-3115 or 877-235-9091 speak with a Billing Department representative.
| Required Supporting Documentation | Examples of Acceptable Documentation |
|---|---|
| Confirmation of Annual Income | Most Recent Federal Income Tax Return Last 4 pay stubs Most recent W-2 or 1099 Social Security Award Letter Full Bank Statements for recent 3 months Unemployment Statement Workers Compensation Award Letter Pension or Retirement Statement Investment Income |
| Verification of Social Security Number and/or Date of Birth | Driver's License State Issued Identification Card Social Security Card Birth Certificate Baptismal Certificate Military Discharge Papers School Records |
| Verification of Residency | Mortgage Statement Rental Agreement/Lease Property Tax Bill Room & Board Statement Utility Bill Written Verification from Landlord |
Return the above documentation to the Financial Office:
PO Box 2197
Batesville, AR 72503
Fax: (870) 262-6547
PO Box 510
Mountain View, AR 72560
Fax: (870) 269-6593
Costs will vary depending on the healthcare service rendered and the setting in which the care is delivered.
You may call us at 870-262-2929 for an estimate.
The Financial Advocate can tell you if you qualify for free or low-cost insurance such as Medicaid. If the Financial Advocate finds that you do not qualify for low-cost insurance, they will help you apply for Financial Assistance to reduce your bill. The Financial Advocate will help you complete all the forms and tell you which documents you need to bring.
Reading Your BillFinancial Assistance PolicyFinancial Assistance Application
Eligibility for financial assistance is based on multiple factors, including the nature of the condition and care required, insurance coverage or other sources of payment (including personal injury claims), income (Federal Poverty Level guidelines used to determine the amount of financial assistance offered), family size, assets, and any special consideration the patient or physician would like to have considered.
Financial assistance is offered to patients who are uninsured and under-insured. Partial or full financial assistance will be granted based on a patient’s ability to pay the billed charges.
Patients must fully comply with the application process, including submitting tax returns, bank statements and pay stubs, as well as completing the application process for all available sources of assistance, including Medicaid or Medical Assistance.
The patient or any person involved in the care of the patient, including a family member or provider, can express financial concerns at any point during the patient’s care. The patient or responsible party will then be encouraged to complete a financial assistance application.
Financial assistance is limited to medical care provided at White River Health System, Inc. facility locations and by White River Health System, Inc. medical personnel. Expenses such as travel, food, lodging, durable medical equipment, and prescriptions are not covered under the Financial Assistance Policy. White River Health System, Inc. will uphold the confidentiality and dignity of each patient, and any information submitted for consideration of financial assistance will be treated as protected health information under the Health Insurance Portability and Accountability Act (HIPAA).
Questions about Applying for Assistance
Should you have questions about applying for financial assistance please do not hesitate to ask any Patient Access Specialist, Financial Counselor or contact White River Health System Business Office at 870-262-1253.
A patient determined to be eligible for financial assistance may not be charged more than amounts generally billed for emergency or other medically necessary care to patients who have insurance for such care.
Translated versions of the application form, financial assistance policy, and this summary, are available upon request.
Revised: 06.30.2020
Effective: 08.01.2020
Policy
Under these principles, the Board of Directors of White River Health System (WRHS) is committed to the provision of financial assistance to patients who are in need of care, have selected WRHS for such care, and a determination has been made that the facility is the most appropriate facility for rendering such care of service and there is no other more suitable facility or program available to such patient where compensated care could be rendered. WRHS follows federal guidelines in making reasonable efforts to determine a patient's eligibility for financial assistance, and utilizes federal poverty guidelines to inform assistance determinations.
It is necessary to adhere to an open door philosophy of furnishing adequate diagnostic and therapeutic services for emergencies in order to avoid claims of improper rejection, inappropriate transfers, or lack of recognition of cases requiring immediate attention in the emergency room. WRHS conforms with existing Emergency Medical Treatment and Active Labor Act (EMTALA) laws and provides treatment for emergency medial conditions. Further, this policy prohibits WRHS form engaging in actions that discourage treatment for emergency medical conditions or by permitting debt collection activities that interfere with the provision of emergency medical care.
Purpose
White River Health System is a not for profit, tax-exempt entity with a mission to provide a safe, efficient delivery of quality healthcare and to improve the health of our communities through education and outreach. WRHS is dedicated to a mission of public financial assistance through providing care for members of our society who benefit from our services without regard to race, sex, creed, national origin, or station in economic or social life. We are committed to making available, in such ways as to preserve human dignity and worth, the full resources of the health system to those persons unable to pay. At the same time, WRHS must operate our facilities in the most efficient and economical manner possible to assure a strong future financial position necessary for the replacement and expansion of facilities, payment of our debts, establishment of adequate reserves for emergencies, the provision of future technological developments, and needed medical services.
Procedures
The following guidelines will be followed in providing financial assistance:
Each request for financial assistance will be evaluated on its own merits utilizing established patient accounts procedures based on this policy. Evaluation of the need for a particular patient will likely include such factors as:
Requests for financial assistance may come from doctor's offices or community-minded interested party. Each requester will be required to fill out the WRHS financial assistant application unless the requesting party can show that a like form has been completed for the applicant.
All patients should be offered a financial assistance application at the time of registration and/or discharge from our facility upon request. If this evaluation is not conducted until after the patient leaves the facility, or in case of outpatients or emergency patients, a Financial Counselor will mail a financial assistance application to the patient for completion. In addition, the hospital will provide information regarding how to obtain a Plain Language Summary of the financial assistance policy to the patient within the first 120 days following the first billing statement.
Uninsured patients and patients who qualify for financial assistance will not be charged for emergency or other medically necessary care at rates higher than the amounts generally billed (AGB) to third-party payers. The use of gross charges to such patients is prohibited. For purposes of this policy, WRHS uses the look back method to determine the AGB. The current AGB discount of 60% applies at White River Medical Center and Stone County Medical Center as of August 1, 2020 (08/01/2020).
Uncompensated/reduced compensation services will be limited to those patients whose family income is below 300% of the national poverty guidelines. The prevailing national poverty guidelines will be the basis for determining eligibility and can be requested in writing, free of charge from the hospital.
Uncollectable accounts, accounts that were not reviewed by financial counselors at the time of service, and/or questionable collectible amounts may qualify for financial assistance during the collection process if they met the above criteria.
In the following situations (known as presumptive financial assistance), a patient is deemed to be eligible for 100% reduction of charges
In the event of a patient's death, the family of the deceased patient will be eligible for our Presumptive Charity discount by presenting a copy of the patient's death certificate. Once collection efforts have been met, the remaining balance will qualify for Presumptive Charity.
WRHS will provide any member of the public or state governmental entity a copy of our financial assistance policy and application upon request, free of charge. The policy can be requested by calling WRHS Patient Financial Counseling Office at 870-262-1118 or by mail at 1710 Harrison Street, Batesville, AR 72501. The policy is also available online at www.whiteriverhealthsystem.com, at all points of the registration within the facility, and also provided via mail to any requester, free of charge. A plain language summary of the policy is available in these locations as well. Notices of this Financial Assistance Policy will also be included on billing statements.
This Financial Assistance Policy applies only to WRHS hospital charges and does not include charges that are not billed via White River Medical Center (WRMC). This policy only applies to emergency and medically necessary services and may not apply to elective procedures. See attached list of providers covered by our policy.
All approved financial assistance at White River Medical Center and/or Stone County Medical Center will be valid for six(6) months from the date patient or representative submits application to assist with the expense of upcoming care: unless, patient's source of income is Social Security, financial assistance will be valid for 12 months. All approved financial assistance will apply retroactively for three(3) months, or, from the most recent episode causing applicant to file for assistance.
This policy will be applied equally to all patients regardless of payer source. Applications that do not meet the criteria set forth in our policy may, in extraordinary circumstances, be approved by the Chief Financial Officer.
Policy
WRHS provides uncompensated, reduced compensation, or discount services to all eligible persons unable to pay.
Eligibility for uncompensated services is limited to persons whose verifiable family income is equal to or less than 150% of the current poverty income guidelines as established by the Department of Health and Human Services.
Eligibility for reduced compensation services is limited to persons whose verifiable family income is greater than 150% of the current poverty income guidelines but not greater than 300% of the current poverty income guidelines as established by the Department of Health and Human Services.
Accounts that have been placed with a third party collection agency are eligible for benefits provided requiring they meet appropriate set guidelines. If approved, the account will remain with the collection agency but will receive the approved financial assistance reduction. All accounts place with a third party collection agency are eligible for a 35% settlement discount, upon request via patient or representative, if paid in full.
Acceptable household income verification for our Financial Assistance Application includes:
White River Health System reserves the right to pursue collections activity on unpaid balance if the patient or representative does not meet the agreed upon schedule.
White River Health System sends account statements to patients on a monthly cycle. The first statement is sent to the patient 30 days after discharge or 30 days after insurance is completely processed. If no payment is received, a second statement is issued 30 days after the first statement. If no payment is received, a final notice is mailed to the patient stating the payment must be received within 30 days of notice to prevent assignment to a third party collection agency. Accounts with no payment within 30 days of final notice are reviewed by the WRHS Patient Financial Services office to ensure all reasonable efforts to determine eligibility for financial assistance have been met prior to assigning to a collection agency. WRHS will make reasonable efforts to orally notify the patient about our Financial Assistance Policy and how they may obtain assistance with the process before the account is placed with a third party collection agency. Any collection agency utilized by WRHS will agree to refrain from abusive collection practices. Reasonable efforts include notifying individuals of this Financial Assistance Policy upon admission/discharge, and in written or oral communications with the individual concerning his or her bill. Extraordinary collection efforts include filing lawsuits, placings liens on residences, reporting adverse information to consumer credit reporting agencies or credit bureaus, writ of civil action, and other similar activities.
Purpose
To ensure that requests for uncompensated service, reduced compensation services, and discount services are handled consistently, accurately, and timely.
Responsibility
WRHS Revenue Cycle Director
WRHS Patient Financial Services Associates
Procedure
Process Steps:
| Discount | 100% | 90% | 80% | 70% | 0% | ||
|---|---|---|---|---|---|---|---|
| Family Size | 100% | 138% | 150% | 200% | 250% | 300% | 400% |
| 1 | $12,760 | $17,690 | $19,140 | $25,520 | $31,900 | $38,280 | $51,040 |
| 2 | $17,240 | $23,791 | $25,860 | $34,480 | $43,100 | $51,720 | $68,960 |
| 3 | $21,720 | $29,974 | $32,580 | $43,440 | $54,300 | $65,160 | $86,880 |
| 4 | $26,200 | $36,156 | $39,300 | $52,400 | $65,500 | $78,600 | $104,800 |
| 5 | $30,680 | $42,338 | $46,020 | $61,360 | $76,700 | $92,040 | $122,720 |
| 6 | $35,160 | $48,521 | $52,740 | $70,320 | $87,900 | $105,480 | $140,640 |
| 7 | $39,640 | $54,703 | $59,460 | $79,280 | $99,100 | $180,920 | $158,560 |
| 8 | $44,120 | $60,886 | $66,180 | $88,240 | $110,300 | $132,360 | $176,480 |
Adds $4,480 per family member exceeding 8.
| Balance | Month Term |
|---|---|
| $100-500 | 6 Month Maximum Term |
| $501-1,000 | 12 Month Maximum Term |
| $1,001-2,500 | 18 Month Maximum Term |
| $2,501-5,000 | 24 Maximum Term |
| $5,000+ See Financial Counselor for arrangements | |
Services covered under the White River Health System Financial Assistance Policy include White River Medical Center, Stone County Medical Center, all WRHS owned clinics excluding our rural clinics and primary care clinics. Approved financial assistance will be honored by all participating clinics (as listed below) for all future care visits following the application approval date. WRHS clinics will only honor retroactivity pertaining to patient’s most recent episode. It is patient’s responsibility to communicate approved financial assistance with the participating clinics as needed.
Batesville Neurology Clinic
Batesville Oncology Clinic
Batesville Pulmonology Clinic
Stone County Medical ER
White River Orthopaedic Sports and Hand Surgery Clinic
WRHS Anesthesia
WRHS ER Physicians Group
WRMC Cancer Care Center
WRMC Cardiology
WRMC Hospitalist Group
WRMC Orthopaedic and Sports Medicine Clinic
WRMC Pain Management Clinic - All locations
WRMC PROS Therapy Services - All locations
WRMC Rheumatology Clinic
WRMC Sleep Center
WRMC Surgery Clinic
WRMC Wound Healing Center - All locations
WRMC Wound Care Physicians
Para calificar recibir la asistencia financiera se estudia varios factores, incluyendo la clase de su condición y la atención requerida, cubertura de seguro u otros fuentes de pago (incluso reclamos de indemnización por daños corporales), sus ingresos (el lineamiento que define lo que es el Nivel de Pobreza Federal será utilizado para determinar la cantidad de asistencia financiera brindada), tamaño de la familia, bienes, y cualquier tema en particular que el paciente o el médico solicita que se toma en cuenta. La asistencia financiera se podría otorgar a los pacientes quienes no tienen seguro de salud o tienen seguro limitado. Asistencia financiera parcial o completo se otorgaría dependiendo de la capacidad del paciente de poder pagar los cobros facturados.
El paciente deberá colaborar completamente con el trámite de la solicitud, incluyendo la presentación de sus declaraciones de impuestos, estado de cuentas bancarias y talones de pago, tanto como cumplir los trámites para solicitar asistencia de otras fuentes disponibles, entre ellas Medicaid o Asistencia Médica.
El paciente u otra persona involucrada en el cuidado del paciente, incluyendo los parientes del paciente o un proveedor, puede expresarse preocupación financiera en cualquier momento durante el tratamiento del paciente. En aquel entonces, el paciente o la persona responsable por él será animado llenar una solicitud pidiendo asistencia financiera.
La asistencia financiera se limita a la atención médica brindada por los empleados de White River Health System, Inc. únicamente en las instalaciones de White River Health System, Inc. Los gastos como de viaje, comida, hospedaje, equipos médicos duraderos y medicina recetada no serán cubiertos por el Programa de Asistencia
Financiera. White River Health System, Inc. protegerá la privacidad y dignidad de cada paciente, y toda información revelada para sostener la solicitud de asistencia financiera será tratada como información protocolizada según la ley HIPAA (Health Insurance Portability and Accountability Act).
Si tenga usted preguntas sobre como solicitar asistencia financiera, favor de consultarse de inmediato con un Representante de Servicio al Paciente, un Asesor Financiero, o comunicarse con un funcionario de la oficina de Gestión de White River Health System al (870) 262-1253.
Un paciente quien califica por la asistencia financiera no será cobrado más de los montos generalmente cobrados por servicios de emergencia u otros servicios médicos necesarios en comparación con el monto cobrado a los pacientes quienes tienen seguro de salud.
Hay versiones traducidas a otros idiomas de: la solicitud, la política sobre asistencia financiera, y este resumen; todos los cuales están disponibles a petición.