Uninsured Prompt Pay Discount Policy - Gundersen Health System

Uninsured Prompt Pay Discount Policy
GL-1085
Applicable To
All employees of Gundersen Lutheran Health System, Inc. and its affiliates including Gundersen Clinic, Ltd.
and Gundersen Lutheran Medical Center, Inc. (hereinafter, collectively referred to as “Gundersen Lutheran” or
“GL”).
Policy
As part of our charitable mission, Gundersen Lutheran is committed to providing benefits to the Community.
There are four categories of Community Benefits:
Charity care and discounts for uninsured and underinsured patients.
Non-reimbursed cost of governmental programs.
No-charge services, donations, and sponsorships targeted to underserved populations.
No-charge services, donations, and sponsorships for the broader
community.
As a nonprofit, charitable, community-based healthcare provider, Gundersen Lutheran will provide medically
necessary services at reduced or no charge to patients who meet specified criteria. These criteria are objectively
determined and shall be consistently applied across the Gundersen Lutheran Delivery Systems. Effective
communication between all areas of the Patient Business Services Department and all Gundersen Lutheran
medical facilities will be established and maintained to assure the consistent application of these procedures.
Gundersen Lutheran periodically reviews its charity care and uninsured prompt pay discount policies to ensure
fulfillment of its mission to provide medically necessary health care to eligible uninsured or underinsured
patients in need of such services. Gundersen Lutheran provides its hospital board with details of the discounts
provided pursuant to its charity care and uninsured prompt pay discount policies as well as the administration of
the policies, at least once annually.
It is important to distinguish between individuals who can afford to pay and choose not to (Bad Debt), and those
who cannot afford to pay (Charity Care). Gundersen Lutheran reserves the right to revise, modify or change this
policy as necessary or appropriate.
Below are the procedures to be followed by Gundersen Lutheran Patient Business Services
personnel when applying discounts for uninsured patients.
Implementation
Financial Assistance
A. Communication to Patients
Subject to EMTALA requirements, when a patient is admitted to a Gundersen Lutheran hospital, checked-in by
a receptionist at a Gundersen Lutheran clinic, or initially contacted by a Home Health representative, he or she
should be notified that payment in full is expected at the time of service. If this is not possible, the patient
should be advised of our policy regarding installment payments. At this time, insurance or other payment source
will be identified and recorded.
However, neither of these procedures will be followed in any situation that may violate EMTALA provisions.
In that instance the patient’s insurance status will be recorded as soon after stabilization as possible. If a patient
does not have insurance coverage or cannot provide evidence of such, he or she will be classified as "Self-Pay"

within the patient financial system. Patients who have been classified as “Self-Pay” will automatically have
information about the uninsured discount printed on their billing statements.
Information on Gundersen Lutheran payment policies is posted in the patient registration areas of the institution
and from financial aid counselors throughout the organization, as well as the
corporate website www.gundluth.org. In addition, Gundersen Lutheran’s payment policies are
printed on the reverse of all Gundersen Lutheran clinic and hospital billing statements and are
available at any time upon patient request.
B. Applying the Discount
Gundersen Lutheran will provide an uninsured prompt pay discount to uninsured self-pay patients receiving
eligible services at all Gundersen Lutheran facilities. This discount will be applied upon notification to
Gundersen Lutheran Customer Financial Service by the patient or guarantor that they are requesting the
uninsured prompt pay discount, Gundersen Lutheran Customer Financial Services has confirmed that the patient
is an eligible uninsured self-pay patient and the balance, less the uninsured prompt pay discount amount, has
been paid in full.
Gundersen Lutheran Customer Financial Service may be contacted either by phone at 608-775-8660, or in
writing at Gundersen Lutheran, 1900 South Ave., Mailstop NCA3-01, Attention Customer Financial Services,
La Crosse, WI 54601.
The discount will be at least equal to the weighted average percentage discount offered to the three largest nonself-insured,
non-affiliated third party payers. The discount will be calculated annually at the end of the 1st
quarter of each calendar year and shall remain in effect until the end of the first quarter of the following
calendar year.
The uninsured prompt pay discount will be:
Balance Discount Rate Timeframe from the date of the first
statement for Payment in Full
Any balance 10% 31-90 calendar days
Up to $2500 15% 30 calendar days
$2,500.01-$9,999.99 20% 30 calendar days
$10,000 and greater 25% 30 calendar days
Patients may request the discount by contacting Gundersen Lutheran Customer Financial Services. The discount
may apply if the eligible patient qualifies for discounting under GL’s charity care policy.
An important element in offering the above discount is the patient’s prompt payment of the bill for the services
rendered, or the patient’s prompt arrangement with Gundersen Lutheran to make payment. The patient shall
remit payment in full within the time frame outlined in the above discount table to receive an uninsured prompt
pay discount.
If full payment is not made within the timeframe outlined in the above discount table, the account will continue
along the normal cycle of accounts receivable up to and including referral to the collection agency.
Patients have the right to appeal a denial of the uninsured prompt pay discount to the Manager of
Customer Financial Services at 608-775-8670, or in writing to Gundersen Lutheran, 1900 South Avenue, Mail
Stop NCA3-01, La Crosse, WI 54601.

Gundersen Lutheran reserves the right to reverse the discounts described herein in the event that it reasonably
determines that such terms violate any legal or contractual obligations of Gundersen Lutheran.
C. Eligibility Criteria
All uninsured self-pay patients are eligible for the uninsured prompt pay discount, regardless of geographic
location or residency status, provided the patient requests the uninsured prompt pay discount by contacting
Gundersen Lutheran Customer Financial Services and provides payment in full within the timeframe outlined
above in the discount table, allowing Gundersen Lutheran Customer Financial Services to confirm the
uninsured self-pay status of the patient.
Any elective procedures are not eligible for the uninsured prompt pay discount including, but
not limited to, the following:
Cosmetic/plastic surgery
Bariatric surgery
Lasik eye surgery
Dental services
Vision services/Eyewear
Orthodontics
Hearing Aids
Fertility
Chiropractic
Unity House
For scheduled/unscheduled/non-emergent or elective services, if the patient’s financial history indicates
consistent nonpayment and the patient is not eligible for other payment sources or assistance programs, the
patient may be requested to make payment arrangements to fulfill past due balances prior to scheduling
additional non-emergent or elective services.
D. Determination of Eligibility
All uninsured self-pay patients are eligible for the uninsured prompt pay discount provided the patient requests
the prompt pay discount by contacting Gundersen Lutheran Customer Financial Services and provides payment
in full within the time frame outlined above in the discount table, allowing Gundersen Lutheran Customer
Financial Services to confirm the uninsured self-pay status of the patient. No other eligibility is required.