Mammogram Assistance Information
PURPOSE:
To provide funding assistance for Breast Cancer screening mammograms to eligible women and men; contingent upon the availability of board approved budgeted resources.
PROCEDURE:
When the need for a mammogram is clinically indicated & recommended by practitioner
- The client/patient’s eligibility for inclusion in the State sponsored Breast and Cervical Cancer Program (BCCP) will be reviewed, and if funding is available, she/he will be enrolled into the BCCP program;
- If BCCP funding is not available, the client/patient may submit an application for financial assistance to The Waterfall Community Health Center (WCHC) Mammogram Assistance Program (MAP).
- The WCHC MAP application will be reviewed, eligibility confirmed, level of available assistance will be determined and, if applicable, offered to eligible client/patient
A.
Waterfall Community Health Center patients will be eligible to apply for free or reduced cost breast cancer screening mammograms under the following criteria:
a. Age 40 and older.
b. Breast and Cervical Cancer Program (BCCP) funding is not available.
c. Oregon Resident
d. Household income level less than 250% of the federal poverty level (see attached guidelines). Clerical staff to verify income eligibility
e. Uninsured or underinsured: Insurance does not pay for preventive health exams, e.g. mammogram. (obtain copy of insurance card) Billing staff to verify
B.
If client is immediately deemed eligible for mammogram program assistance, the WCHC staff will;
a. Generate a numbered MAP voucher for the client/patient
b. Schedule an appointment with the appropriate radiology provider,
c. Provide a copy of the signed/approved MAP voucher to the client/patient
d. Fax a copy of the signed/approved MAP voucher to the radiology provider office
e. Place a copy of the MAP voucher in the client/patient chart
f. Place a copy in the MAP program assistance file
C.
If client has insurance coverage, the process is as follows:
a. A copy will be made of the patient’s insurance card for the MAP file.
b. The patient will be instructed that their insurance company will be contacted and coverage or lack of coverage for screening mammograms will be confirmed via the billing office in an attempt to ascertain eligibility for the MAP.
c. The patient will receive a follow-up phone call from staff with notification of the outcome and instructions for date/time of mammogram appointment if applicable.
d. A numbered voucher will then be created and the process will mirror the process in “B” above.
2009 Federal Poverty Guidelines
Waterfall Community Health Center: Mammogram Assistance Program
Income Eligibility for 250% of Poverty Level
(Based on 12 months)
| Size of Family Unit | Annual Income | Monthly Income |
|---|---|---|
| 1 | $27,075 | $2,258 |
| 2 | $36,425 | $3,035 |
| 3 | $45,775 | $3,815 |
| 4 | $55,125 | $4,595 |
| 5 | $64,475 | $5,373 |
| 6 | $73,825 | $6,153 |
| 7 | $83,175 | $6,933 |
| 8 | $92,525 | $7,710 |
(a) To determine Annual Federal Poverty Level for family units with more than eight members, add $9,350 for each additional member.
(b) To determine Monthly Federal Poverty Level for family units with more
than eight members, add $779 for each additional member.
SOURCE: BCCP Income Eligibility (Last updated 07.08.09)