Financial Assistance Program
|
Please read the following carefully and click the Financial Assistance Application link at the bottom of the page when ready to fill out your application.
|
Financial Assistance Program Procedure for Madison County Health Care System
Financial Assistance Program is a Madison County Health Care System funded program that provides financial assistance to applicants who fall within the financial criteria of the sliding fee scale based on the federally established poverty guidelines. Financial Assistance is applied towards medically necessary services provided by Madison County Health Care System and its affiliate providers.
Financial Assistance discounts are not applicable towards Hospitality care, elective surgical procedures, or services that are not billed by Madison County Health Care System (i.e. Ambulance, Prescriptions filled at a Pharmacy, Specialty Clinic Physician charges or medical equipment charges from See the Trainer). Questions regarding which charges are covered by Financial Assistance Program can be directed to the Patient Accounts Manager at 462-9738.
Financial Assistance Program applications are available at the Admissions Desk by the Emergency Department, Heath Trust Physicians Clinic and Earlham Medical Clinic registration desks or at the Patient Accounts Office. Please completely fill out the application and return it with a copy of your most recent Federal Income Tax return to:
Patient Accounts Manager
Madison County Health Care System
300 W. Hutchings St.
Winterset, IA 50273
Applications must be filled out within 1 year after services are received or prior to services being rendered, if possible. The application must be signed by all adults in your household. Financial Assistance cannot be applied to any account(s) that have been turned over to an outside collection agency, have had or are in the process of legal action. Eligibility for the Financial Assistance Program is determined using the most recently filed income tax return with eligibility typically ending June 1st. If the tax return provided is not the current year’s return the duration of eligibility may be shorter at the discretion of the Financial Assistance Committee. Finanacial Assistance can be renewed by reapplying after eligibility has expired. Once your application has been reviewed by Madison County Health Care System’s Financial Assistance Program Committee a letter declaring your status will be sent to you within 3 weeks. An Eligibility Card showing Financial Assistance Program benefits will be issued to the Patient and eligible family members. The Eligibility Card must be presented each time services are rendered in order to receive Financial Assistance Program benefits.
All patients without regard to race, color, sex, age, handicap, religion, national origin, political belief or payor source are eligible for charity care as long as they meet all other criteria stated in the Madison County Health Care System Financial Assistance Program Policy.
|
|
