Financial Assistance Guidelines
Lawrence County Memorial Hospital offers financial assistance to patients who have demonstrated an inability to pay for services.
In order to qualify the patient must complete a Statement of Financial Obligations and Credit Report Authorization and send copies of supporting documents. The preferred documents include last year income tax return, last month bank statement, and last two pay stubs.
The application must be completed fully and accurately. If you require assistance in completing the form LCMH has qualified Patient Account Representative available.
Upon receipt of the application and supporting documentation the following criteria will be used in examining the financial application:
Individual or family income (All household income must be reported.)
Individual or family net worth, considering all liquid and non-liquid assets owned less liabilities and claims against assets.
Family size
Employment status
Financial obligations including living expenses and type of loan obligations
Ratio of monthly income to monthly debt
Amount and frequency of bills for healthcare services
To determine the amount of financial assistance write-off the Federal Register for poverty guidelines will be followed. Additionally, if you are uninsured you may qualify for an uninsured patient discount if your gross family income is less than 300% of the Federal Poverty Level for your family size. The application must be completed annually. If the patient feels that there is a significant change in their financial status an additional application can be completed in less than 12 months. |  |
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