Please read all of our financial assistance guidelines below before applying
Financial Assistance (Charity Care) Policy
Lakewood Community Acupuncture (LCA) is a 501(c)3 nonprofit organization committed to affordable holistic healthcare. Our cost for acupuncture services are approximately 1/3 the cost of private acupuncture in our area, and our herbal medicine and supplements are always 25% off retail cost.
Our lower cost makes our services accessible to most income levels, however, if your personal financial situation is such that you are unable to afford our low-cost model, we invite you to apply for financial assistance.
Our financial assistance program allows for reduced cost or free community acupuncture services, depending on need and availability, and is made possible through our Pay It Forward program.
Upon acceptance, we will ask you to sign, in person, a commitment form agreeing to the following, which is presented here to review before you go through with the application.
- To always arrive on time to my appointments. If I am late, my appointment will be canceled and one treatment will be deducted from my allotted Pay It Forward treatments. If this happens 3 times, I will lose my Pay It Forward scholarship.
- To not miss any appointments, without at least 24 hr advanced notice. If I cancel within 24 hrs of my appointment, one treatment will be deducted from my allotted Pay It Forward treatments. If this happens 3 times, I will lose my Pay It Forward scholarship.
- To be respectful of the time of the acupuncturists and staff, understanding that in order to offer discounted services to myself and others, every moment of their time is valuable.
- To follow my treatment plan and stick to the number of treatments agreed upon per week to get the best results for my condition.
- To do any homework in between sessions (dietary changes, exercise, heat therapy, rehabilitation, etc) to get the best results for my condition.
- To be committed to my health and wellbeing and will be an active member in my healing process.
- I understand that my continuing to receive discounted services is completely dependent on me being a model patient.
This policy serves to establish and ensure a fair and consistent method for the review and completion of requests for reduced cost or free community acupuncture and natural health care to our patients in need.
It is the policy of LCA to offer financial assistance to patients who are unable to pay their clinic bills due to difficult financial situations. An LCA Manager, or committee with authority to offer financial assistance, will review individual cases and make a determination of financial assistance that may be offered.
LCA determines the need for financial assistance by reviewing the particular services requested, a person's historical financial profile and current financial situation. This method allows for a fair and accurate way to assist patients who are experiencing financial hardship. Partial and/or full charity care will be granted based on the individual’s ability to pay the bill.
Income – Assuming that other financial resources are not identified as viable funding sources, the Federal Poverty Income Guidelines will be used in determining the amount of charity care. The Poverty Guidelines are updated annually each January.
The minimum criteria for full (100 percent) charity care will be 200 percent of the most recent Federal Poverty Income Guidelines.
Minimum criteria for partial treatment coverage will be to grant patients earning between 201 and 400 percent of the Federal Poverty Income Guidelines some level of discount depending on the circumstances in each case, but averaging a 50 percent discount for all patients in this income level bracket.
LCA may allow discounted services to patients with income levels over 400 percent of the Federal Poverty Guidelines, depending on the market served and other charity care options available within the community.
Evaluation of the Patient’s Monthly Expenses – review of living expenses includes medical expenses and other basic needs.
Nature of the Medical Condition or Care Required – consideration of services unique to LCA versus potential of other local facilities providing care.
Any special circumstances that the patient would like LCA to consider. Eligibility is contingent upon patient cooperation with the application process, and submission of all information that LCA deems necessary in order to determine the level of any financial assistance that may be considered, including written permission for LCA to check consumer credit information. Priority is given to requests for care of local patients, and to care that is unique to LCA.
Measures to Publicize LCA’s Financial Assistance Policy
When accepting applications, LCA will make a copy of this Policy available by posting it on their webpage including the ability to download a copy of the Policy free of charge. Individuals in the community served will be able to obtain a copy of the Policy at our LCA location or by downloading from our website.
Procedure for Financial Assistance Identification of Patients Who May Be Eligible
Patients or their representatives may request financial assistance prior to receiving services or after they have received services and have determined that they need assistance to continue with our services. Financial aid is not applied to services previously paid for. Financial aid may be used for future services only. Patients who want to apply for financial assistance or who have been identified as a potentially eligible for financial assistance, will be informed of the application process upon inquiry.
All patients/guarantors must submit the following documents that serve as the minimum information necessary to process an application for financial assistance. LCA reserves the right to request additional documentation before finalizing a request for assistance:
- Proof of household income (including pay stubs)
- Proof of household annual income (including copy of the most recent tax return)
- Full disclosure of claims and/or income from personal injury and/or accident related claims
A Manager or designated committee will review all returned Financial Statements for completeness. Once a decision has been made for financial assistance, a manager or committee member will contact each applicant advising them of the decision.
Basis for Calculating the Amounts Charged to Patients
The amount that a patient is expected to pay and the amount of financial assistance offered depends on the patient's income and assets as set forth in the eligibility section of this Policy. The Federal Income Poverty Guidelines will be used in determining the amount of the charity care and the amount charged to patients, if any, after an adjustment.
Eligibility Criteria Considered for Financial Assistance
A Manager or designated committee will review all circumstances surrounding the request. The LCA entity will notify the patient about the decision within a reasonable time after submitting a completed financial assistance request. A patient's request will be deemed complete after LCA receives a complete financial assistance application, and all required documentation, including current pay stubs, income tax statements, and bank statements, if applicable.
Delivery of charity care does not obligate LCA to provide continuing care. Patients may be required to reapply for charity care at least every 180 days, or after a designed treatment course has been completed.
Reasons for Denial
LCA may deny a request for financial assistance for a variety of reasons including, but not limited to:
- Sufficient income
- Sufficient asset level
- Patient is uncooperative or unresponsive to reasonable efforts by LCA staff to work with the patient
- Requests for care when there is no identifiable means of obtaining long-term support needed to sustain the initial successful outcomes of care
- Incomplete Financial Assistance application despite reasonable efforts by LCA staff to work with the patient
- Program not available at this time, due to lack of funds in LCA's Pay It Forward program
LCA is committed to upholding all federal and state laws that preclude discrimination on the basis of race, sex, age, religion, national origin, marital status, sexual orientation, disabilities, military service, or any other classification protected by federal, state or local laws.
LCA will uphold the confidentiality and individual dignity of each patient. LCA will meet all HIPAA requirements for handling personal health information.