Patient Financial Assistance Program and Application

Fletcher Allen is a patient-centered organization committed to treating all patients equitably, with dignity and respect regardless of the patient's health care insurance benefits or financial resources. We are committed to providing financial assistance to persons who have essential health care needs and are uninsured, underinsured, ineligible for a government program or otherwise unable to pay, for medically necessary care based on their individual financial situation.

Your ability to pay for services should not prevent you from receiving the medically necessary care you need. Fletcher Allen has financial assistance programs in place to help you, in the form of discounted, deductible-based or free care for those patients who do may not have the financial resources to pay their bills.

Financial Assistance Discounts

For the uninsured patient, Fletcher Allen offers a discount for medically necessary care. Note: Cosmetic, non-medically necessary (e.g., IVF, Sterilization reversals), case rate services, are some examples of services not eligible for the discount.

• Fletcher Allen uninsured discount = 30%
• If single service provided is >$5,000 an additional prompt pay discount is available = 20%
• To receive the additional discount, payment in full is due at time of service. Note: An uninsured patient is defined as one who is not enrolled in a third party health insurance plan.

For our international patients, Fletcher Allen offers a discount for care if paid in full at time of service. Please contact our Financial Counselors at fahcpfc@vtmednet.org for more information.

Patient Assistance (Free Care / Charity Care)

For our patients who express financial hardship, Fletcher Allen offers a free care or deductible-based assistance program, sometimes referred to as "charity care".

Our program is based upon the Federal Poverty Level Guidelines (FPLG) and eligible patients must pass both an income and assets test to qualify. In addition:

• Patients must live in our service area. They must be full time Vermont residents or residents living greater than 6 months in Vermont, or in the following New York counties: Clinton, Essex, Franklin, Washington, Hamilton, Warren or St. Lawrence
• Patients living outside of the service area would qualify for emergency care only
• Service must be medically necessary (e.g. Cosmetic, IVF, Sterilization reversals, are not eligible)
• Patients who are eligible for government sponsored programs are required to apply for Medicaid or Catamount Health before they will be considered for this program
• Patients income and assets must be below 400% of the FPLG
• Patients above 400% of the FPLG are invited to present extenuating circumstances in the form of a letter to be reviewed by an appeals committee
• If services are above 400% of the FPLG and are catastrophic in nature, coverage is available when the balance due exceeds 50% of the annual household income

To be considered for free or deductible-based care program, please complete the Patient Assistance Application (PAP) form and return, along with the required supporting documentation to:

Fletcher Allen Health Care, Inc.
P.O. Box 1810
Burlington, VT 05402-1810
Attn: Patient Assistance Program

If you have questions regarding our financial assistance programs or application status, please contact our Customer Service department at (802) 847-8000 or (800) 639-2719 or via email at customerservice@vtmednet.org.

If you have any questions or need assistance with the applications process for Vermont or New York Medicaid or Catamount Health please contact our Financial Counseling department at (802) 847-1122 or via email at fahcpfc@vtmednet.org.

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