Policies and Important Information
What kind of medical care would you want if you were too ill or hurt to express your wishes? Advance directives are legal documents that allow you to convey your medical care preferences. They communicate your wishes to family, friends, and health care professionals and may eliminate any confusion or disagreement if you’re unable to speak for yourself (if you are in a coma, for example).
Advance directives include:
- Living Will – A living will is a written, legal document that describes the types of medical treatments or life-sustaining treatments you would or would not want if you were to become seriously or terminally ill. These treatments may include tube feeding, mechanical breathing (ventilator), or kidney dialysis. A living will does not let you select someone to make decisions for you. It is called a “living will” because it takes effect while you are still living. In Washington and Idaho, you do not need a lawyer to complete your living will.
- Durable Power of Attorney for Health Care (DPAHC) –This legal document states whom you have chosen to make health care decisions for you if you are unconscious or unable to make medical decisions. While you can select almost any adult to be your agent, you should select a person(s) knowledgeable about your wishes, values, religious beliefs and in whom you have trust and confidence and who knows how you feel about health care. You should discuss the matter with the person(s) you have chosen and make sure they understand and agree to accept the responsibility. A notary or two witnesses are required to finalize a durable power of attorney for health care.
- Do Not Resuscitate Order (DNR) – A DNR is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Unless given other instructions, hospital staff will try to help any patient whose heart has stopped or who has stopped breathing. An advance directive form can be used to tell your doctor that you don’t want to be resuscitated, or you can simply tell them your decision. Your decision will be noted in your medical chart.
Should I have an advance directive?
By creating an advance directive, you are making your preferences about medical care known before you’re faced with a serious injury or illness. This will spare your loved ones the stress of making decisions about your care while you are sick. Any person 18 years of age or older can prepare an advance directive.
Our Case Managers are professional licensed nurses and social workers who work closely with patients, family members, physicians, the hospital health care team, insurance companies and community resources to efficiently coordinate an excellent transition of care.
Tri-State Memorial Hospital has three Case Managers who are key members of the patient’s treatment team. They work closely with all disciplines to provide excellent patient care, which can include obtaining authorizations for care from insurance companies, setting up patient follow-up appointments, coordinating home health care services, assessing equipment needs and ensuring medications are ordered.
For more information, contact the Case Management department at 509.758.5511 ext. 2144.
To offer greater transparency regarding hospital pricing and negotiated payer allowances, you can view information regarding 300+ shoppable services by following the link below. There is an additional link below to view data offered through the Washington State Hospital Association about hospital charges for specific services.
- COVID-19 Test Pricing
Cost: $138.00 plus shipping and collection = $209.00*
*Please note that test prices fluctuate due to the limited availability of test kits.
Hospital-Based Outpatient Care
“Provider-Based” or “Hospital-Based Outpatient” refers to the billing process for services rendered in a hospital outpatient clinic or location. This is the national model of practice for integrated health systems involved in patient care and Tri-State follows these very specific billing practices as mandated by the Center for Medicaid & Medicare Services.
This means that patients may receive two bills: one from the hospital (the technical component) and one for the practitioner’s professional services.
- Scheduled admission, including surgeries, must have financial arrangements in place prior to date of service. A deposit will be requested for the portion of charges not covered by insurance, such as co-payment, co-insurance, non-covered, and deductible amounts.
- It is the guarantor’s responsibility to make appropriate financial arrangements with Tri-State Memorial Hospital.
- Payment contracts that extend past 12 months must be approved by Tri-State Memorial Hospital. Co-pays are required at time of service for all office visits (primary care providers and specialists). A $100 deposit is required for all uninsured patients.
Pre-service deposits are required for certain scheduled services performed at Tri-State Memorial Hospital. An estimate of your financial responsibility and deposit unique to each scheduled service is available by calling 509.254.2716.
Tri-State Memorial Hospital accepts MasterCard, Visa, Discover, and American Express. Health Savings Account (HSA) and Flexible Spending Account (FSA) payments are also accepted.
For HSA/FSA guidelines, please refer to www.irs.org.
- Tri-State Memorial Hospital will bill your insurance company if your current insurance card is presented at time of registration.
- At time of registration you will be asked to sign a form authorizing your insurance company to assign insurance benefits to Tri-State Memorial Hospital.
- You are expected to pay for charges that are not covered by your insurance such as co-payment, co-insurance, non-covered, and deductible amounts.
- Tri-State Memorial Hospital will provide an estimate for out-of-pocket costs.
- It is your responsibility to meet the requirements of your insurance policy for pre-approval of your hospital and/or clinic service(s).
- It is your responsibility to provide details related to injury or incident to your insurance company. Questions regarding insurance coverage or benefits must be directed to your insurance company.
A finance charge will accrue on accounts 90 days after the first billing statement. If Tri-State Memorial Hospital has billed insurance, the finance charge will begin accruing on the balance determined to be patient responsibility 90 days after insurance pays. If your insurance company does not pay within 90 days, the account balance will be considered patient responsibility and interest will accrue on the full balance.
The effective interest rate will be .75% per month, which corresponds to an annual percentage rate of 9%. The finance charge will be figured by applying the monthly interest rate to the adjusted account balance (previous balance minus current payments and credits, plus any new charges).
Prompt Pay Discount
A discount of 10% is available to uninsured patient balances paid in full within 30 days of first billing cycle.
Tri-State Memorial Hospital will bill Medicare for your service. In addition, Tri-State will bill your Medicare supplement. For any service not covered by Medicare, you will be asked to sign an Advanced Beneficiary Notice (ABN) prior to treatment. An ABN is considered your acceptance of financial responsibility for a non-covered service. You may be asked to pay upfront for these services.
At time of registration, a Medicaid recipient must present their current medical card. Registration will verify eligibility prior to treatment.
For services that are the result of a work-related injury, Tri-State Memorial Hospital will need the following information in order to submit a claim:
- Employer name, address, and phone number
- Date, time, and location of injury
- Claim number, if applicable (You must notify your employer of any on-the-job injury. Your employer will need to submit additional information to the industrial carrier.)
For services related to a motor vehicle accident, Tri-State Memorial Hospital will submit a bill on your behalf once the following information is received:
- The name of the responsible party
- Date, time, and location of accident
- The name and phone number of the responsible party’s auto insurance carrier and agent name
- The guarantor’s auto insurance company name, phone number, and agent name
Financial Assistance may cover necessary or emergent medical treatment received from a hospital or clinic. The level of assistance received is based on family income and eligibility criteria provided by The Department of Health and Human Services.
If you feel you are in need of financial assistance, please call Financial Services at 509.758.4652.
Tri-State Memorial Hospital & Medical Campus understands high deductibles and coinsurances mean that you are likely paying more out of your own pocket for health care services. We know that uncertainty about the financial side of receiving health care can be distressing and we want to help as best we can. We are pleased to offer patient financial estimation services based on your medical benefits and our reimbursement contract with your health plan. You can obtain an estimate by contacting a Patient Access Representative at 509.254.2716.
At Tri-State we make every reasonable effort to be accurate, but estimates are not a guarantee. To help ensure the best estimate possible, we recommend that you also talk with the Member Services Department at your health plan or other applicable insurer. They are the most knowledgeable and up-to-date about the status of your benefits and eligibility. You can usually find their contact information on your member identification card.
Tri-State Memorial Hospital & Medical Campus is committed to supporting the Centers for Medicare & Medicaid Services (CMS) effort to build transparency and awareness of hospital pricing and quality. We have a published version of our chargemaster, which is our full price listing, available to you in machine readable format should you wish to view it. The chargemaster contains industry specific language and coding that can make it confusing to navigate, and because the health plans negotiate the proprietary fee allowances, it does not accurately reflect nor provide your actual out-of-pocket costs. For these reasons, we suggest obtaining an estimate as described above. Should you still wish to obtain the chargemaster, please call the Contract Analyst at 509.758.5511 ext. 4675.
Pay Your Bill Online
To make fast, easy, and secure payments online, visit www.TriStateHospital.org and click on “Bill Pay” at the top of the homepage.
Payments may also be made in-person at the Tri-State Business Office located at 1100 Highland Avenue, Clarkston, WA or by phone at 509.758.4652.
- Regence Blue Shield of Idaho
- Blue Cross of Idaho (excluding Clearwater Provider Network)
- Premera Blue Cross (including Lifewise)
- First Choice
- Idaho Medicaid / Healthy Connections
- Coordinated Care (Washington Medicaid & Health Insurance)
- Noridian Medicare
- Regence Blue Shield of Idaho, Medicare Advantage
- Blue Cross of Idaho, Medicare Advantage
- Veterans Affairs (VA) / TRICARE
- Community Health Plan
- United Healthcare
Questions relating to a provider’s preferred, participating, network or non-network status will be the responsibility of the patient. The patient is responsible for meeting the requirements of their insurance policy and all questions regarding insurance coverage or benefits must be directed to your insurance company.
Contact Financial Services if you would like to pay a bill, add or update insurance, or have any questions regarding your bill or how insurance is processed.
Location: 1100 Highland Avenue, Clarkston, WA 99403
Office Hours: Monday – Friday, 8:00am – 5:00pm
Helpful Phone Numbers
Many doctors, ambulance companies, and labs are separate companies with their own billing and account procedures. Below is a list of groups who regularly provide care for patients at Tri-State Memorial Hospital. If you receive a bill from any of these companies please contact them with any questions pertaining to your
- Pathologists’ Regional Laboratory – 800.443.5180
- Lewiston Orthopedic Associates – 208.743.3523
- Valley Medical Center – 208.746.1383
- Lewiston Ambulance – 208.743.3556
- Lewis Clark Gastroenterology – 208.746.3309
Last Updated 1.1.2021
Mission of the Hospital with Respect to Financial Assistance
Uninsured or under-insured patients may be eligible for financial assistance regardless of race, creed, color, national origin, sex, sexual orientation, or the presence of any sensory, mental, or physical disability or the use of a trained dog guide or service animal by the disabled person.
Financial assistance will be made publicly available in accordance with WAC 246-453-020(2).
Tri-State Memorial Hospital Financial Assistance program will be made available to patients seeking care at the Washington campus, and Idaho Clinics; Tri-State Family Practice Lewiston and Tri-State Clearwater Medical Clinic.
Description of Eligibility Criteria
Financial Assistance is available to qualified uninsured or under-insured patients for appropriate hospital and clinic based medical services in accordance with WAC 246453 section 010 which states: “Those hospital services which are reasonably calculated to diagnose, correct, cure, alleviate, or prevent the worsening of conditions that endanger life, or cause suffering or pain, or result in illness or infirmity, or threaten to cause or aggravate a handicap, or cause physical deformity or malfunction, and there is no other equally effective more conservative or substantially less costly course of treatment available or suitable for the person requesting the service. For purpose of this section, “course of treatment” may include mere observation or, where appropriate, no treatment at all.
Eligible services include Emergency Room and Minor Care, Hospital Inpatient, Outpatient and Observation, Clinic services; including Family Practice, Internal Medicine, Rheumatology, Nephrology, Surgical Specialists, Urology, Tele Health, Infectious Disease, Pulmonology, Diabetes Education, Medical Nutrition Therapy and Behavioral Health. Hospital outpatient services; including Sleep Lab, Wound Care, Podiatry, Respiratory Therapy, Day Surgery, Endoscopy, Pain Clinic, Radiology, Dialysis, Laboratory and lnterventional Pain Consultants; including outpatient surgical services.
Many doctors, ambulance companies, and labs are separate businesses with their own billing and account procedures. Although this list is not all-inclusive, the groups that regularly provide care for patients at Tri-State Memorial Hospital are Kootenai Heart Clinics, Lewis Clark Kidney & Hypertension, Lewiston Orthopedics, Valley Medical Center, Catalyst Medical Group, Rural Physician Group, Pathologist Regional Laboratory, Lewiston/Clarkston Ambulance, MedStar/LifeFlight, St. Joseph Regional Medical Center Providers, Larsen Gastroenterology, Valley ENT, Jennifer Kaufman, Dr. Dettwiler, Gem State Endoscopy, Dr. Berg. If you receive a bill from one of these entities and have questions about it, please contact them.
Financial Assistance is generally secondary to all other financial resources available to the patient, including group or individual medical plans, worker’s compensation, Medicare, Medicaid or medical assistance programs, other state, federal, or military programs, county aid, third party liability situations (e.g., auto accidents or personal injuries), or any other situation in which another person or entity may have a legal responsibility to pay for the costs of medical services.
Exclusions/Services not eligible for Financial Assistance: Office visit co-pays, elective services; such as sterilization procedures, Ideal Protein and HMR, Sports Physicals, Department of Transportation Physicals, contracted Occupational Health, elective circumcision, Spa services, retail products, or any other service determined to be “not medically necessary” by the health insurance plan.
Uninsured or under-insured patients will have the opportunity to be considered for Financial Assistance under this Financial Assistance policy based upon the following criteria calculated upon the patient’s financial documentation at the time of the request. Potential patient responsibility will be determined upon the sliding fee schedule and may have an expectation of payments set forth within Tri-State Memorial Hospital’s collection policy:
A. The full patient balance for hospital charges will be evaluated to determine Financial Assistance eligibility for any patient whose gross family income is at or below 100% of the current federal poverty guidelines. Patients whose gross family income are 101% to 200% of the current federal poverty guideline will be eligible for a discount of 75% to be applied to the patient account balance and will be determined as a Financial Assistance discount.
Patients whose gross family income is 201% to 300% of the current federal poverty guideline will qualify for a discount of 35% applied to the patient responsibility.
B. ‘Prima Facie’ Write-offs: the hospital may choose to grant Financial Assistance based solely upon the initial determination. Any patients who are on state assistance, are unemployed, transient or incompetent may be valid “prima-facie” candidates. In such cases, the hospital may not complete full verification or documentation of any request.
C. Special Consideration Financial Assistance: Uninsured and under-insured Washington and Idaho patients may qualify for a discount. Determination will be made by Leadership upon patient’s completion of the Special Consideration Financial Assistance Application and the specified supporting documentation as proof of severe financial hardship or personal loss from time of request based on economic situation.
D. Tri-State Memorial Hospital emergency room services and outpatient primary care sites will utilize only income and famiy size in determination of Financial Assistance eligibility, per National Health Services Corp. (NHSC) sliding fee requirements.
Process for Eligibility Determination
The hospital will make an initial determination of eligibility based upon verbal or written application for Financial Assistance. In the event a patient cannot provide documentation supporting their application for Financial Assistance, Administrative discretion will apply.
A determination will be made upon the receipt of all requested information from the responsible party, including applications and supporting documentation within fourteen (14} days of receipt of a Financial Assistance application. No collection efforts will be made for parties during the determination process for Financial Assistance in accordance with WAC 246-553-010(1 }, WAC 246-453-020(1 )(a}, and WAC 246-453-020(1 }(c).
The hospital will exercise the following options:
A. The hospital shall use an application process to determine qualification for Financial Assistance.
Requests to provide Financial Assistance will be accepted from sources such as physicians, community or religious groups, social services, financial services personnel or the patient/family. When the hospital becomes aware of factors which might qualify the patient for Financial Assistance under this policy, the patient will be advised of this potential and will make an initial determination that such account is to be treated as Financial Assistance.
Final Determinations: The hospital will exercise the following options in making the final determination for Financial Assistance:
Option 1: Financial Assistance may be granted based solely on the initial determination. In such cases, the hospital may not complete full verification or documentation of any request. This falls within the Prima Facie guidelines.
Option 2: When financial screening indicates potential need, Financial Assistance applications and instructions shall be furnished to patients. All applications, whether initiated by the patient or the hospital should be accompanied by documentation to verify income amounts indicated on the application form. Any one of the following documentation items may be acceptable for purposes of verifying income:
- Last year’s 1040 Federal tax form.
- “W-2” withholding statement.
- Letters approving or denying Unemployment Compensation.
- Letters approving or denying Medicaid medical assistance.
- Pay stubs with year to date earnings from all household employment.
- Written statements from employers or welfare agents.
- Other acceptable documentation, should none of the above be accessible: Schedule C Federal tax form, current bank statements, student loans and/or grants, Social Security Awards Letter, other legal document showing dependent(s).
Option 3: During the initial request period, the hospital may pursue other sources of funding including Medicaid, Crime Victims, or County Aid for Idaho residents.
Option 4: Income shall be based on prior years Federal tax return and include documentation of current economic situation. In the absence of tax forms, current pay stubs (3) will be accepted. Income will be calculated from the documentation provided by the patient or Medicaid. The process of calculation will be determined by the hospital and will take into consideration seasonal employment and temporary increases and/or decreases of income.
Time Frame for Final Determinations: The hospital shall provide final determination within fourteen (14) calendar days of receipt of a complete application.
In the event that a responsible party pays a portion or all of the charges related to appropriate medical services, and is subsequently found to have met the financial assistance criteria at the time that services were provided (via completed application), any payments in excess of the amount determined to be appropriate in accordance with WAC 246-453-040 shall be refunded to the patient within thirty days of achieving the financial assistance designation.
Denial appeals: Denials will be written and include instructions for appeal or reconsideration as follows: The responsible party may appeal the determination of eligibility for Financial Assistance by correcting any deficiencies in documentation to the Patient Accounts Manager or designated representative. Upon the receipt of an appeal, there will be a thirty (30) day hold in the collection process. The Chief Financial Officer will review and respond to all appeals within fourteen (14) days of receipt. If this review affirms the previous denial of Financial Assistance, written notification will be sent to the patient/guarantor and the Department of Health, in accordance with state law. If the denial is reversed the patient shall immediately be declared an eligible candidate
- Collection efforts will cease if an appeal has been filed for Financial Assistance in accordance with WAC 246-453-020(9)(b).
Staff Training, Documentation and Records
A. Confidentiality: All information relating to the application will be kept confidential. Complete copies of documents that support the application will be kept with the application form.
B. Documents pertaining to Financial Assistance shall be retained for four (4) years.
C. Staff Training: Standardized training based on this Financial Assistance Policy and the use of interpreter services to assist persons with limited English proficiency and non-English-speaking persons in understanding information about the availability of Financial Assistance will be provided on an annual basis. The training shall help ensure staff can answer Financial Assistance questions effectively, obtain any necessary interpreter services, and direct inquiries to the appropriate department in a timely manner.
Financial Assistance Application
Click Here to download the Financial Assistance Application (also known as “Charity Care”) at Tri-State Memorial Hospital & Medical Campus.
If you have any questions, please contact one of our Patient Financial Counselors at 509.758.4651 or 509.758.4653.
Financial Assistance- Plain Language Summary
Click Here to download the Financial Assistance Plain Language Summary at Tri-State Memorial Hospital & Medical Campus.
Effective: 07/2012 / Last Revised: 07/2021
We are an approved National Health Service Corp site!
As a National Health Service Corps site, we promise to:
- Serve all patients
- Offer discounted fees for patients who qualify
- Not deny services based on a person’s:
- National origin
- Sexual orientation
- Inability to pay
- Accept insurance, including:
- Children’s Health Insurance Program (CHIP)
As a patient of Tri-State Memorial Hospital, you have the right:
- to have a family member or representative and your own physician notified promptly of your admission to the hospital.
- to care that respects you as a person, as well as your values, beliefs and culture.
- to receive care that meets the high quality standards set by Tri-State Memorial Hospital.
- to personal privacy.
- to receive care in a safe environment, free from abuse or harassment.
- to have information about your care and treatment shared only with those responsible for your care.
- to have your pain managed effectively.
- to understand your health status and be part of decisions about your care.
- to be part of decisions about not using or withdrawing lifesaving or life sustaining treatment.
- to have someone make treatment decisions for you, if you are unable.
- to receive help in preparing for your return home or to another facility.
- to assistance with special needs, such as guardianship or protective services.
- to access information contained in your medical record within a reasonable time.
- to be free from any form of restraints, unless medically necessary.
- to report quality concerns or submit a formal complaint.
As a patient of Tri-State Memorial Hospital, you have the responsibility to:
- be accurate and complete in giving your medical history.
- carry identification with you.
- notify caregivers if your health changes.
- ask questions and take part in your health care decisions.
- let us know if you don’t understand any part of your treatment.
- let us know when you are having pain or when your pain is not being managed.
- treat staff and other patients with respect.
- regard other patients’ medical information as confidential.
- respect hospital property and equipment.
- examine your hospital bill and ask questions.
- pay your bill promptly; if there is a hardship, let us know so we may help you.
- tell your caregivers if they have not fulfilled their commitment to your care or showed concern and respect for you.
If you would like to report quality concerns or submit a formal complaint, contact the Community Relations Department at 509.254.2719 or email.
Concerns or complaints that have not been resolved, may be directed to the Washington State Department of Health Public Relations at 1.800.633.6828.
Tri-State ensures the security and privacy of your medical records.
In order to get a copy of your medical records from Tri-State Memorial Hospital & Medical Campus, you must submit a signed and dated Authorization For Release of Protected Health Information Form.
Mail or hand deliver to:
Tri-State Memorial Hospital & Medical Campus
1221 Highland Ave.
Clarkston, WA 99403
Fax to: 509.758.3566
Please make sure to include the following information to help ensure quick processing of your request:
- Name (or patient’s name)
- Date of birth
- Date(s) of service and which records are being requested from Tri-State Memorial Hospital & Medical Campus
- The address to which you want your records sent
- Your telephone number
- Your signature
If you are signing for someone other than yourself, please be sure to indicate on the form what your relationship to the patient is. Also, if you state you have Power of Attorney, are named as the Healthcare Representative in an Advanced Directive, or have legal guardianship rights, you must provide that documentation, along with the completed form.
There may be a fee associated with your request for medical records. Health Information Management will contact you prior to releasing the records, if a fee is incurred”.
Call Tri-State’s Medical Records Department at 509.758.5511 ext. 3320 with any questions.
Requesting Medical Records of a Deceased Patient
Please contact the Medical Records Department at 509.758.5511 ext. 3320. You may need to provide additional documents in order to obtain a copy of the records.