Charity Care Policy

Clinch Valley Medical Center has a Charity Discount Policy that provides free hospital care for patients who have received non-elective care, do not meet the qualifications for Medicaid and whose income is at or below 200% (in most cases) of the Federal Poverty Level. In order to qualify for this free care, you must complete a Financial Assistance Application and provide documentation to support your income. The full Charity Discount Policy is listed below.


Policy Statement

Clinch Valley Medical Center is committed to providing quality health care to all, regardless of their ability to pay. The Charity Care Policy is designed to allow relief of all or part of the charges that exceed a patient's reasonable ability to pay. These patients must meet certain income requirements, do not qualify for state or federal assistance and are unable to establish partial payments or pay their balance in full.

The following classes of patients may qualify for a charity discount:

  • Under insured patients (i.e., those patients with some form of third party payer coverage for health care services but such coverage is insufficient to pay the current bill) when indigence is established and the out of pocket responsibility is $1,000 or higher. 
  • Uninsured patients (i.e., those patients with no third party payer coverage for health care services whatsoever), which have advised that they are unable to pay their account balances. 

All patients who are able will be expected to pay for their own health care services to avoid shifting the burden for their care to other patients and the general public. The Charity Care Policy should have no impact on the collection policies and practices with regard to those balances that do not qualify for charity care. Failure to honor payment arrangements on amounts exceeding the charity adjustments may result in the total charity care being revoked.


To qualify for charity care consideration up to 200% of the FPG (Federal Poverty Guideline), the patient must apply for all entitlement programs accepted by Clinch Valley Medical Center for which he or she is eligible (i.e. Medicaid, SLH, Social Security Disability, Vocational Rehab, etc.). A validation must be completed by the hospital to ensure that any portion of the patient's medical services can be paid by a federal or state governmental health care program (e.g., Medicare, Medicaid, Champus, and Medicare secondary payer), private insurance company, or other private, non-governmental third-party payer. No charity discount can be applied to any account with any outstanding payer liability.

All Medicare accounts and all non-Medicare inpatient accounts will be required to have supporting income verification documentation. Medicare requires independent income and resource verification for a charity care determination with respect to Medicare beneficiaries (PRM-1 § 312).

For Medicare beneficiaries, in addition to thorough completion of the Financial Assistance Application, the preferred income documentation will be the most current year's Federal Tax Return. Any patient/responsible party unable to provide his/her most recent Federal Tax Return may provide two pieces of supporting documentation from the following list to meet this income verification requirement:

  • State Income Tax Return for the most current year 
  • Most recent employer pay stubs 
  • Written documentation from income sources 
  • Copy of all bank statements for the last three months 
  • Current credit report 

The completed application along with the supporting income validation documentation (State Income Tax Return, Employer Pay Stubs, Bank Statements, etc.) should be mailed to:

Richmond Patient Account Services
Attention: Charity Department
7300 Beaufont Springs Drive
Richmond, VA 23225

If the patient has private health insurance and does not supply adequate information for Clinch Valley Medical Center to obtain reimbursement (i.e. failure to provide Coordination of Benefits information), assistance will not be considered.

Patients should allow 20 business days for the review process. The Charity Department will then notify the Patient/Responsible party of their determination by letter.


To qualify for Clinch Valley Medical Center's Charity discount effective January 1, 2009, the patient's gross annual income must be less than the figure shown for 200% of the poverty level. Local state guidelines may require a different percentage. If the patient/responsible party's total family income exceeds the table shown, the patient/responsible party does not qualify for a Charity discount.

Family Size Federal Poverty Level 0-200% Poverty Level
1 $11,770 $0 – $20,800
2 $15,930 $0 - $28,000
3 $20,090 $0 - $35,200
4 $24,250 $0 - $42,400
5 $28,410 $0 - $49,600
6 $32,570 $0 - $56,800
7 $36,730 $0 - $64,000
8 $40,890 $0 - $71,200

*For family units with more than 8 members, add $4,160 for each additional member to meet the Poverty Level.

The Federal Poverty Levels are based on the 2015 Health and Human Services Poverty Guidelines.


All medically necessary charges are covered under the Charity Care Policy. The following services are generally not covered under the Policy:

  • Physician's fees (other than hospital employed physicians) 
  • Optional private room or suite accommodations 
  • Elective procedures (not medically necessary), i.e. cosmetic surgery including gastric by-pass, sterilization and reversal of sterilization 
  • Equipment or services supplied by Clinch Valley Medical Center affiliates other than hospitals or physicians employed by the hospital.