III. Self-Pay Patients


Question 1: How do the HCRA surcharges apply to self-pay patients?

Question 2: Does the 2% administrative fee that providers can deduct from their Public Goods Pool reports apply to what is collected from uninsured (self-pay) patients?

Question 3:If a consumer does not have health coverage, are they obligated to pay the HCRA surcharge?



Question 1: How do the HCRA surcharges apply to self-pay patients?

Answer 1: Self- pay patients are those that lack third party coverage in whole or in part, which includes those that have exhausted their health care benefits or receive services not covered by their plan. As uninsured persons, they must make surcharge payments directly to providers when billed. Since these persons are not third party payors that must make an election decision whether to elect into the Public Goods Pool or not, their surcharge obligations are limited to the Self-Pay/Uninsured/Unspecified rate. Additionally, these patients are not required to pay the regional GME percentage surcharge on inpatient services.

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Question 2: Does the 2% administrative fee that providers can deduct from their Public Goods Pool reports apply to what is collected from uninsured (self-pay) patients?

Answer 2: No. The 2% administrative fee applies only to revenue received from those third party payors, as defined in PHL Section 2807-j, that did NOT make an election with the PGP (non-electors). Uninsured patients are not third party payors as defined in PHL Section 2807-j and cannot make an election to submit directly to the Public Goods Pool. Providers are given a 2% administrative fee for collecting the surcharge on the state´s behalf from those payors that had an election decision to make and chose to not elect(non-electors).

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Question 3: : If a consumer does not have health coverage, are they obligated to pay the HCRA surcharge?

Answer 3: Individuals lacking third party coverage in whole or in part, are obligated to pay the Self-Pay/Uninsured surcharge rate directly to the provider when billed.

New York Individuals lacking third-party coverage are encouraged to contact the programs below to determine if they qualify for coverage: Child Health Plus (800)-698-4543; Family Health Plus (877)-934-7587; Healthy New York (866)-432-5849. More detailed information can be found under Health Insurance Programs found on www.nyhealth.gov.

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