Self-Pay Billing & Collections Policy

POLICY: Cottage Hospital, by obligation or as a courtesy, bills all patients’ third-party payers (TPP) prior to billing the patient. The same billing and reimbursement methods are available to patients regardless of the patient’s ability to pay.


  • Each patient with a Third Party Payer (TPP), is billed for any out of pocket amounts stated by the TPP remittance advice, which includes for example any deductibles, co-pays, co-insurances, etc.  If the patient has more than one TPP, Cottage Hospital will bill each of those as appropriate prior to billing the patient.
  • Cottage Hospital out sources all self-pay accounts with balances above $9.99 to a credit and collection vendor.  This vendor sends bill notices and attempts telephone calls to encourage payment of the outstanding balance with Cottage Hospital.  Both Cottage Hospital, and our collection vendor, notifies the patient of Cottage Hospital’s reimbursement options which are:
    • Time Pay Plans – Payment plans are negotiated to pay the account balance in full within a reasonable amount of time.  Except in unusual circumstances, payment plans will be approved based on the following guidelines.
      Balance Payment Plan
      Under $1,500 18 month payment plan.  One eighteenth of the balance paid each month.
      $1,501 to $5,000 24 month payment plan. One twenty-fourth of the balance paid each month.
      $5,001 to $9,000 36 month payment plan. One thirty-sixth of the balance paid each month.
      $9,001 and above 48 month payment plan. One forty-eighth of the balance paid each month.

      *Minimum monthly amount for a payment plan is $20.00
      All request for a time payment plan will be forwarded to the financial counselor.
      Patients will be informed of our policy to approve a payment plan only if the patient can demonstrate a financial hardship.
      If no financial hardship the patient will be expected to seek financial assistance from other sources such as: Bank, Credit Unions, Financial Institutions, credit cards, etc.
      A financial assistance application will be sent to the patient to complete and return with supporting documentation.
      The financial Counselor will review all applications and submit to the Director with recommendations.
      Once a plan is agreed to, a payment contract will be completed. The contract will identify:
      a. Total outstanding balance.
      b. The $ amount of each monthly payment.
      c. The dates the first payment is due.
      d. The number of payments to be made.
      e. Patient responsibility for any collection fees, interest and court cost if they default on payments.

      The Payment Plan Contract must be signed by the patient / guarantor and witness.
      A completed payment plan will be maintained in the Financial Counselor’s file until the account is paid in full.
      If multiple accounts are to be considered for a payment plan, the total of all the accounts will be used to establish the monthly payment and the number of months approved to pay the outstanding balance. Once a plan is approved, new accounts cannot be added to the payment plan without a the completion of a new financial assistance application.

    • Payments are due every 30-day. At the end of 30-days without a payment, a reminder notice is sent with a demand for the previous month’s payment and the current month’s payment. If no payment is received within 60-days, the account reverts to a standard balance due in full and the account reverts to the standard collection method.
    • Prompt Pay Discounts – Cottage Hospital offers a 10% prompt pay discount, when payment is received within the first 30-days of the billing cycle. Prompt Pay Discounts will also be given to patients participating with NH Access Plus. This discount will be adjusted off the account using transaction code 450.
    • New Hampshire Access Plus (NHAP) Program – Cottage Hospital understands there are persons that do not have insurance or other third party payers. These Patients may qualify for a program called NH Access Plus, which grants a 25% discount on charges. To qualify, candidates must sign an attestation that states they do not participate with any other insurance or third party payers. The transaction code for this discount is 451.
    • Cottage Hospital accepts Credit Card Payments. The credits card we accept are:
      American Express VISA Master Card Discover Card
  • Our collection vendor follows a standard billing timeline for balances $10 or greater.
    • Day 0: Cottage Hospital electronically transmits balances to the vendor
    • Day 1: Vendor sends first bill notice to patient.
    • Day 31: If partial payment is not received, vendor sends a second bill notice.
    • Day 45: If partial payment is not received, vendor initiates telephone contact.
    • Day 61: If partial payment is not received, the vendor sends a third past due bill notice.
    • Day 75: If partial payment is not received, vendor initiates second telephone contact.
    • Day 91: If partial payment is not received, vendor sends a final notice to the patient of past due bill and identifies actions to be taken if not paid within 30 days.
    • Day 121: Vendor sends review notice to Cottage Hospital identifying accounts outstanding to determine if the accounts are to be sent to collections.
  • If at any time during the collection process, the patient states that they do not have, or have very limited resources to pay for their healthcare services, the patient is given a Cottage Care application and is encouraged to apply for the program (see separate policy Financial Assistance Policy 903.02).
  • If at any time during the collection process a Bankruptcy notice is received:
    • Accounts not with an outsourced vendor, the Financial Counselor will verify the patient’s name, address and social security number and place account on hold stopping all collection activity until final notice received and/or account adjusted for bankruptcy. Actions taken documented on account.
    • If account is with an outsourced vendor, they will verify the account information. If the data is a match, the outsource vendor will halt all collection activity including statements or phone calls until the account is canceled or restarted.
    • If account is with an outsourced vendor, they will verify the account information and if matching data will halt all collection activity; will not send statements or make phone calls until the account is canceled or restarted.
    • Vendor will forward the bankruptcy notice in the original envelope to the hospital financial counselor. Document account of action taken.
    • In 30 day intervals will review account for status change.
    • Day 91, will review with Financial Counselor to determine action be taken. Cancel account or restart collection cycle.
    • Day 120, if not action taken, restart collection cycle at day 30.