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Financial Assistance Policy


As part of our commitment to ensuring access to high quality medical care to all members of our community, the Hospital will provide care for emergency medical conditions to those in need, regardless of insurance status, ability to pay or eligibility for financial assistance under this Policy.

The need for financial assistance may be a sensitive and deeply personal issue for recipients.  Confidentiality of information and preservation of individual dignity shall be maintained for all who seek financial assistance.  No information obtained in the patient’s application for financial assistance may be released unless the patient gives express permission for such release, except to bona fide governmental agencies requesting aggregate data.

The hospital will widely publicize this Financial Assistance Policy.  Employees in the registration, financial services and emergency departments will be fully versed in this Policy, have access to the financial assistance application forms, and be able to direct questions to appropriate Hospital representatives.

Notices of this Policy will be posted in prominent locations throughout the Hospital including, but not limited to, the emergency department, billing office, and the inpatient and outpatient registration area.  The notices will be clearly visible to the public.  This policy will also be linked to the hospital’s website.

Patients will be provided with information about this Policy upon request, including specific information as to how eligibility is determined and the means of applying for assistance.

Patients who qualify for financial assistance will not be charged for emergency or other medically necessary care at rates higher than the amounts generally billed to third-party payers.  The use of gross charges to such patients is prohibited.

Financial assistance may be granted prospectively or retrospectively.  All persons applying for or receiving financial assistance shall be treated with dignity and respect by Hospital staff and any billing/collection agencies.  All overdue accounts will be reviewed internally to determine whether any financial assistance is available prior to the initiation of any legal proceedings or collection action outside of the Hospital.


The federal Poverty Guidelines provide the initial framework for determining an individual’s eligibility for financial assistance based on earned income.  Other factors that will be considered when determining eligibility include, but are not limited to, investments, financial accounts, real estate, other assets, family size, net worth, employment status, earning capacity and other financial obligations. When other resources are identified, these cases should be referred to the business office supervisor and/or manager for special consideration.

For income levels at 120% of the Poverty Guidelines an 80% discount will be given. For incomes at 200% of the Poverty Guidelines, a 60% discount will be given.  For incomes at 250% of the Poverty Guidelines, a 40% discount will be given.  For incomes at 300% of the Poverty Guidelines, a 20% discount will be given.

This Financial Assistance Policy is limited to Hospital charges and does not include physician or professional charges that are not billed by the Hospital.  Financial assistance is limited to medically necessary services, is not available for elective procedures, is not available for deductibles and co-pays, or for any accounts for which a third party may be liable.


  1. Patients requesting financial assistance will be provided with an application for financial assistance.Application materials will include a notice to patients that upon submission of a completed application, including any information or documentation needed to determine eligibility.The patient may disregard any bills from the Hospital until a decision has rendered on the application.

  2. Completed financial assistance applications with supporting documentation should be returned to the Financial Counseling Department for verification.Applications for financial assistance for inpatient services should be accompanied with a Medicaid denial.Renewal applications for financial assistance for outpatient recurring services should also be accompanied with a Medicaid denial.

  3. Patients who do not provide the requested information necessary to completely and accurately assess their financial situation in a timely manner and/or who do not cooperate with efforts to secure governmental healthcare coverage may not be eligible for financial assistance.

  4. Financial assistance eligibility will be determined by the Financial Assistance Specialist or other designated individual.The criteria for discount eligibility will apply equally to all patients regardless of payer.

  5. Discounts will generally be provided based on a sliding scale as noted above and based on then current Federal Poverty guidelines. Patients who do not meet established criteria may receive discounts in extraordinary circumstances with the documented approval of the Chief Executive Officer.

  6. Patients will be notified in writing of the Hospital decision concerning eligibility for financial assistance within thirty (30) days of receipt of an application.

  7. If a patient has applied for and received financial assistance within the past twelve (12) months, and the patient’s financial circumstances have not changed, the patient will be deemed eligible for financial assistance without having to submit a new application.

  8. Applications for financial assistance will be maintained for one (1) year.

  9. In the event a patient approved for financial assistance fails to comply with payment terms for a period of more than one hundred and twenty (120) days, the account may be turned over to a collection agency or reported to a credit agency in accordance with normal collection procedures.Any collection agencies used by the Hospital will agree to refrain from extraordinary collection practices.

  10. Patients with low or moderate incomes who incur catastrophic health expenses beyond their insurance coverage or own ability to pay may be provided catastrophic protection by limiting payment liability to twenty-five percent (25%) of annual household income.Determinations to provide catastrophic protection will be made by the Chief Executive Officer.

  11. A 50% uninsured allowance will be available to all patients without insurance and who do not qualify for any financial assistance, for inpatient or outpatient services.This discount is calculated by averaging the discount given to all payers, including Medicare and commercial insurance companies.This uninsured discount will be updated annually and distributed by Administration to all departments one month prior to the start of the new fiscal year, to be effective on the first day of the upcoming fiscal year.

This Financial Assistance Policy shall be reviewed annually to determine appropriateness to current community and financial needs. Any revisions must be approved by the Board of Directors.