Charity Care

Bergen Regional Medical Center Charity Care Income Criteria And Required Information

(Revised June 2013) en Español

Patients are required to submit at least one (1) document from each of the four (4) categories listed below:

1. Valid Identification

  • Drivers License – Valid (unexpired)
  • State/County ID
  • Social Security card
  • Birth Certificate
  • If Homeless with none of the above forms of identification - Attestation form will be completed

2. Proof Of New Jersey Residency For Date(s) Of Service

  • Utility bill for date of service
  • Valid (unexpired) drivers license with current address
  • Support letter (if not working and living with someone)
  • If Homeless with none of the above forms of residency - Attestation form will becompleted

3. Income Information

  • If employed, must present one of the following:
    • Weekly income - Four (4) most recent pay stubs
    • Bi-Weekly income - Two (2) most recent pay stub
    • Letter from employer on company letter head (to include beginning date of employment, hourly wage and number of hours worked weekly)
  • Self employed- profit and loss statement
  • Disability income (Social Security awards letter must be presented advising of monthly amount received)
  • Social Security - Provide most current letter from Social Security advising monthly amount received
  • Worker’s Comp - Pay stubs or letter from fund must be provided. Letter must include date
  • Worker’s Comp began, hourly rate and weekly hours worked, Based on Gross Income.
  • If unemployed - Unemployment statements. If receiving direct deposit, patient will need to obtain proof directly from Unemployment by calling 609.292.2460.
  • Pension payments - Present most current letter from pension stating how much received and how often
  • Insurance or Annuity payments - Present most current letter from insurance or fund
  • stating how much received and how often
  • Plan G income for that month/public assistance
  • Alimony/Child support
  • Rental income from rental property
  • Dividends
  • Monetary support (receiving financial support from friends or family)
  • Letter of support if not working and living with someone.
  • Homeless not working/no income attestation can be completed with a Financial Rep.

4. Asset Information As Of The Date Of Service

  • Bank statement for checking and savings account
  • Life Insurance policy value
  • 401K
  • Stocks/Bonds
  • I.R.A
  • CD
  • T-Bills
  • No bank accounts - attestation will be filled out by Financial Rep.
  • Homeless no assets attestation can be filled out with Financial Rep.

Patients That Are Married

  • Spouses are held to the same Four (4) documentation requirements as the patient
  • Spouse must sign all attestations applicable to them. Download the Patient Attestation form
  • If separated, patient must present spouse ID, income and assets. If there are no financial ties then patient will need to complete an attestation supplied by BRMC

Patients With Children

  • ID (Social Security Card or Birth Certificate) is required for each minor child under 18 (if patient has custody or minor child/children).

Support Letters - Must Present One Of The Following:

  • Pre-print Letter Download the Statement of Support Assistance form
    It is strongly suggested that pre-print support letters be filled out by the person providing support. Supporter must then sign and provide contact phone number.  Supporter must also provide valid form of proof of address as is noted in #2 above.
  • Hand Written Letters Must be dated with the date of admission, entire address with zip code, the relation of the patient to the supporter, length of residency at that address, supporter must attest that the patient does not have any income, assets, job or bank accounts and that free room and board are being provided to them. Supporter must then sign and provide contact phone number.

Patients eligible for less than 100% Charity Care are required and should be prepared to pay a deposit prior to admission. (Patient’s not eligible for 100% charity care may be eligible for Compassionate Billing Discount)
Payments methods accepted are: Cash, Check, Money Order, Visa, MasterCard, American Express

Questions?

Please contact the BRMC Credit and Collections Department at 201.967.4114 or 201.967.4200
Or visit http://www.state.nj.us/health/charitycare/index.shtml

The Affordable Care Act

What You Need To Know About:
Obamacare
Affordable Care Act
Medicaid Expansion
Health Insurance Marketplace

Important Information Effective 1/1/14

If you are currently Self Pay due to being ineligible for Charity Care you need to know:

  • You may be eligible for Medicaid under Medicaid Expansion or Health Insurance under the Affordable Care Act.
  • You will need to complete the application process through the Health Insurance Marketplace.
  • Applications can be completed online at www.Healthcare.gov or www.CuidadoDeSalud.gov. If completing online, you will need an email account, phone that is able to accept text messages and a credit or debit card to make payment for first month’s premium, if applicable.
  • Applications can also be completed through the Health Insurance Marketplace Call Center at 1-800-318-2596, 24 hours per day, 7 days per week. TTY users should call 1-855-889-4325.
  • Failure to complete this application process can result in a tax penalty applied to your tax returns. This penalty will increase every year that you fail to comply.
  • The BRMC Credit and Collections staff, located in Room 130 of the Main Building, is available to assist you in completing this application. The staff can be reached at 201-967-4114.

If you are currently Self Pay and are eligible for Charity Care you need to know:

  • You may be eligible for Medicaid under Medicaid Expansion or Health Insurance under
    the Affordable Care Act.
  • You will need to complete the application process through the Health Insurance Marketplace.
  • Applications can be completed online at www.Healthcare.gov or www.CuidadoDeSalud.gov. If completing online, you will need an email account, phone that is able to accept text messages and a credit or debit card to make payment for first month’s premium, if applicable.
  • Applications can also be completed through the Health Insurance Marketplace Call Center at 1-800-318-2596, 24 hours per day, 7 days per week. TTY users should call 1-855-889-4325.
  • Failure to complete this application process can result in a tax penalty applied to your tax returns. This penalty will increase every year that you fail to comply.
  • Failure to complete this application process will require you to complete a Charity Care application for every service date. The application must be approved prior to any service being rendered. This may lead to delays.
  • The BRMC Credit and Collections staff, located in Room 130 of the Main Building, is available to assist you in completing this application.
    The staff can be reached at 201-967-4114
    Bergen Regional Medical Center, L.P.
    Paramus, New Jersey 07652

If you are currently approved for Charity Care and DO NOT have a Social Security Number you need to know:

  • Charity Care coverage will continue to be offered to you.
  • You will need to apply every time your current approval has expired.
  • You will need to complete the renewal process at least 2 weeks prior to the end of your current approval.

If you are currently approved for Charity Care and have a Social Security Number you need to know:

  • Charity Care coverage may not continue to be offered to you.
  • You may be eligible for Medicaid under Medicaid Expansion or Health Insurance under the Affordable Care Act.
  • You will need to complete the application process through the Health Insurance Marketplace.
  • Applications can be completed online at www.Healthcare.gov or www.CuidadoDeSalud.gov. If completing online you will need an email account, phone that is able to accept text messages and a credit or debit card to make payment for first month’s premium, if applicable.
  • Applications can also be completed through the Health Insurance Marketplace Call Center at 1-800-318-2596, 24 hours per day, and 7 days per week. TTY users should call 1-855-889-4325.
  • Failure to complete this application process will require you to complete a Charity Care application for every service date. The application must be approved prior to any service being rendered. This may lead to delays.
  • The BRMC Credit and Collections staff are available to assist you in completing this application.

If you are currently under Medicaid to include Medicaid Plan G you need to know:

  • You will be required to enroll in a Medicaid Managed Care plan.
  • Bergen Regional Medical Center is currently contracted with Horizon NJ Health.
  • If you wish to receive services at Bergen Regional Medical Center you can elect to do so by selecting Horizon NJ Health as your Medicaid Managed Care plan and by selecting one of the following physicians as your Primary Care Provider.

Rajashree Kantha-Bhatnager, MD — Provider ID # 60060896

Amparo Yuzon, MD — Provider ID # 60038011

Karen A. Kattwinkel, NP — Provider ID # 60119566

  • If you are currently enrolled in a different Medicaid Managed Care and wish to switch to Horizon NJ Health you may do so by calling (866) 472-5338 or (800) 682-9091.
  • The BRMC Credit and Collections staff, located in Room 130 of the Main Building, is available to assist you with any questions. The staff can be reached at (201) 967-4114.

If you have primary coverage through Medicare or Private Insurance you need to know:

  • Based on your primary coverage you are in compliance with Obama care and the Affordable Care Act.
  • If you are covered under Charity Care secondary the continuance of Charity Care is not yet known and we will update you as soon as further information has been made available.

Download a pdf of this information.

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