7 AAC 72.530 - Application for financial assistance
(a) An application
for assistance that is submitted under
AS
47.31.015(a) must include
(1) a copy of the invoice for the services
for which financial assistance is sought;
(2) proof of gross monthly household income;
this proof includes paycheck stubs, tax records, unemployment check stubs, a
signed statement from an employer, or any other document that shows evidence of
income for the month during which a patient received care provided by a
designated facility; and
(3)
identification of and information about any third-party payor that provides
insurance coverage to the patient; for purposes of this paragraph, the
following persons are not third-party payors under
AS
47.31.010:
(A) the United States Department of Interior,
Bureau of Indian Affairs;
(B) the
United States Department of Health and Human Services, Indian Health
Service;
(C) the patient's private
insurance company, if the company does not cover mental health inpatient
treatment or the maximum benefit level for that treatment has been
reached.
(b)
If a designated facility makes a notification under
AS
47.31.015(b), the
notification must
(1) be signed and submitted
by the administrator; and
(2)
include
(A) any information as to whether a
thirty-party payor is responsible for payment; and
(c) If the facility receives payment from a
patient or a third-party payor after being reimbursed by the department under
this chapter, the administrator shall return the money to the
department.
Notes
Authority:AS 47.30.660
AS 47.31.015
AS 47.31.090
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