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ORANGE COUNTY HEALTH DEPARTMENT Board of Health Policy and Procedures Manual Section I: Board Adopted Policies Policy E: Fee and Eligibility Policy Reviewed by: Financial Review Committee, Health Director Approved by: Board of Health, Health Director Page 8 of 13 Original Effective Date: January 25, 2001 Revision Dates: 6/28/01; 2/26/04; 11/16/06; 10/24/07; 3/26/09, 3/23/12, 10/15/12, 2/4/13, 8/12/13, 10/22/14, 9/22/15 S:\MANAGERS WORKING FILES\BOH\Policies and Procedures\BOH Policy Manual\2014 BOH P&P Review J. Insurance and Third Party Billing 1. Where a third party is responsible, bills are to be submitted to that party; 2. Third parties authorized or legally obligated to pay for clients at or below 100% FPL are properly billed 3. Third party bills (including Medicaid) show total charges without any discounts unless there is a contracted reimbursement rate that must be billed per the third party agreement. 4. The health department will bill insurance and managed care organizations for which provider approval has been established. The patient will be responsible for all deductibles, coinsurance and non-covered charges. 5. Patient or parent/guardian signature is required to give authorization to file claims and provide necessary information to the insurance company (Attachment E). 6. Patients, or the accompanying parent/guardian of an un-emancipated minor with appropriate insurance benefits, who receive public health services will be given the opportunity to choose whether to have insurance filed in order to avoid breach of confidentiality or pay the associated fee according to where the patient falls on the sliding fee scale.. II.VIII. Review and Approval A. This Policy shall be reviewed annually by members of the Financial Review Committee. The committee shall have representatives from each division, and must also include the Health Department’s Finance and Administrative Services Director B. Any policy revisions must be approved by the Health Director and the Board of Health. VI.IX. Service Limitation/Denial A.I. Services will not be denied based solely on the inability to pay, with the exception of those services that require a flat or minimum fee. Emergency dental services and urgent primary care services will be provided to clients regardless of any outstanding balance due. B.J. Otherwise, services may be denied if the department does not have the resources needed to provide a quality non-mandated service or the individual does not meet the residency or financial requirement. C.K. Family Planning clients will never be refused service due to an outstanding balance or inability to provide proof of income. D.L. Maternal and Child Health clients who are at 60% to 100% pay status may have services limited or denied for failure to make payments based on designated Payment Plans (“good faith” effort). E.M. Falsification of eligibility by the client may result in denial or limitation of services. Formatted: Outline numbered + Level: 1 + Numbering Style: I, II, III, … + Start at: 1 + Alignment: Left + Aligned at: 0" + Tab after: 0.5" + Indent at: 0.5" Formatted: No bullets or numbering