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Financial Questions « Financial Assistance/Charity Care |
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Eligibility Requirements for Financial Assistance |
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Notice of Availability of Uncompensated Services
It is the policy of Moundview Memorial Hospital & Clinics to provide all health care services to its patients, regardless of their ability to pay. If you do not have health insurance or have limited coverage and worry that you may not be able to pay for your care, we may be able to help.
All services at our facility will be available as uncompensated services through the Hill-Burton program; however, if the service is already covered by Medicare, Medicaid, or other health insurance, it will not be covered under the program.
To be eligible to receive assistance under the Hill-Burton program, your household income must be at or below the following levels:
Size of Family Poverty Guidelines
1 ……………………….. $ 21,660
2 ……………………….. 29,140
3 ……………………….. 36,620
4 ……………………….. 44,100
5 ……………………….. 51,580
6 ……………………….. 59,060
7 ……………………….. 66,540
8 ……………………….. 74,020
For each family unit with more than 8 members, add $7480 for each additional member. These figures are 200% of the 2009 poverty income guidelines for all states except Alaska and Hawaii. If you think that you may be eligible for uncompensated services through the Hill-Burton program, you may request an application at the Patient Accounts Department. Moundview Memorial Hospital & Clinics will make a written conditional or final determination of your eligibility for uncompensated services within 2 working days following a pre-service request, or by the end of the first full billing cycle following a post-service request. You must exhaust and show verification on all other potential sources of assistance including Medicaid, Medicare or other Governmental programs. Effective 7/1/2009
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