Policies

Notice of Privacy Practices

Notice of Privacy - English 2021

Notice of Privacy Practices - Spanish 2021

Facilities and Practices covered by the Notice of Privacy Practice

Medical Records

Authorization for Release of Medical Information

Patient Request for Access to Health Information

Guidelines for Email

Financial Assistance Policies

Plain Language Summary

View Plain Language Summary in Spanish

Erlanger has a financial assistance policy (FAP) that provides for free or discounted care(financial assistance) to those who qualify. You can qualify for financial assistance (FA)through presumptive review or an application process.

Erlanger will screen patients for presumptive eligibility based on household income, residence status, mental capacity, Medicaid enrollment, and enrollment in other public means-tested program. If you receive a statement for your care, you did not qualify for FA under the presumptive process.

If you do not presumptively qualify for FA, however, you may still qualify by completing an application and providing required documentation. All persons, whether insured or uninsured, may apply for FA.

Generally, to qualify for FA under the application process, your family income must be 300% or less than the federal poverty guidelines. A patient approved for FA will receive free or discounted (up to 50%) care, and will not pay more for than amounts generally billed for medically necessary care.

This is simply a summary of the FAP. You should review the full policy for additional information, including the time period to apply for FA and care covered under the policy.

You can download copies of the FA policy, summary, and application in English or Spanish using the following links, or ask for copies from an Ambassador/PSR, or by telephone or mail at:

Patient Financial Services (PFS)
3990 E. US Hwy. 64 Alt.
Murphy, NC 28906
828-835-3662

To request more information or to connect to an advocate who can assist you with applying for FA, please call the number listed above or contact Patient Financial Services.

Erlanger Medical Group Clinic Patients

• Financial Assistance Policy
• Financial Assistance Application (Sliding Fee Discount Application)

Erlanger Western Carolina Hospital Patients

• Financial Assistance Policy
• Financial Assistance Application - English
• Financial Assistance Policy - Spanish  (Solicitud de Asistencia Financiera)
• Financial Assistance Application - Spanish

Billing and Collections Policy

Providers Covered under the Financial Assistance Policy

Accessibility Policy

Notice of Program Accessibility for Disabled Policy

Patient Rights and Responsibilities

Patient Rights and Responsibilities - English

Patient Rights and Responsibilities - Spanish (Derechos y Responsabilidades del Paciente)

Reporting concerns

Your quality care and safety is important to us. If you have any unresolved complaints regarding patient care or safety issues, you may report your complaints by doing the following:

Report your complaints directly to the department director or the administrator on-call. Dial “0” on any hospital phone or call 828-837-8161 from an outside phone, and ask for the “Administrator On-call”.

You will receive a prompt response to your concern.

If your concerns cannot be resolved by Erlanger Western Carolina Hospital, you may report them to our accrediting body or the state agency listed below:

The patient has the right to directly contact the North Carolina Department of Health and Human Services (State Survey Agency) or DNV-GL Accreditation Services

NC Division of Health Services Regulation
Complaint Intake Unit
2711 Mail Service Center
Raleigh, NC 27699-2711
www.ncdhhs.gov/dhsr/ciu/complaintintake
Telephone:  1-800-624-3004

DNV-GL Accreditation Services
400 Techne Center Drive, Suite 100
Milford, OH  45150
Telephone: 866-496-9647
Fax: (513) 947-1250
Website: www.dnvglhealthcare.com

For reporting compliance related issues:
Compliance Integrity Line:
877-849-8338

Division of Health Services Regulation 2711 Mail Services Center, Raleigh, North Carolina 27699-2701 Toll Free: 800-624-3004

Language Services