DIAL 911

If you have an emergency


OBJECTIVE: To provide financial options for uninsured, under-insured and indigent patients.
PROCEDURE: Guidelines and review for Charity Care Program.

These guidelines should be used after it has been determined that patient has minimal or no income and is unable to make payment arrangements with the Patient Account Department:

  • Ask the patient if he/she has applied for Medicaid
    • If yes, and denied, we need the denial letter
    • If no, they need to apply.
  • Once all of steps to make payment arrangements have been declined by the patient you can send them the Charity Application, instructions and deadline for competition (15 days after the form is mailed).
  • If the patient neglects to return a completed application, collection activity will resume with the probability of being referred to a collection agency.
  • If the application is returned and is complete, a copy of the documents are scanned to the Patient Account Supervisor/Manager for review.
  • Completed documents are reviewed monthly by the Charity Board (CEO, CFO and Patient Account Manager).
  • Consideration for Charity adjustments are based upon the review of the Department of Health and Human Services and Poverty Guidelines, updated yearly, as below.
  • Patients that meet the set Poverty Guidelines are eligible for 100% discount.


Applied For Medicaid
  • If not applied – direct to application resources
  • If applied
    • Approved
      • Obtain Medicaid Information
      • Bill
    • Denied
      • Confirm there is no other income
      • Move to Charity Application
Charity Application
  • Mail charity application
  • If application is not returned, continue collection activity
  • if application is returned, review and prepare for monthly Charity Board Review
The 2021 poverty guidelines are in effect as of January 13, 2021 for 48 Contiguous States and DC

For families/households with more than 8 persons, add $4,540 for each additional person.

Persons in Family/HouseholdPoverty Guideline