CHARITY CARE CALCULATION:

(Orleans Community Health Financial Counseling staff will do calculations using a Spreadsheet tool to determine patient responsibility)

To calculate a patient’s allowance under Orleans Community Health’s Charity Care policy for qualifying individuals, annual household income is to be divided by the applicable 100% (first column) Federal poverty guideline below for the patient’s family size to arrive at income as a percentage of the poverty guideline. A percentage of the qualifying patient’s charges will be discounted off as indicated by one of the seven ranges below. The remaining balance represents the patient’s payment responsibility.