North Country Hospital

Purpose The financial assistance policy outlined herein is intended to address the interests of providing access to care to those with no or limited means to pay for emergency and medically necessary care. [...] 4204 to request a free paper copy of this policy and the financial assistance applicaon. [...] Eligibility and health insurance sign-up requirements: If a paent is an undocumented immigrant, the paent’s refusal to apply for public health insurance shall not be used as a reason to deny them financial assistance. [...] North Country Hospital may presumpvely deem a paent eligible for financial assistance based on informaon in the hospital’s possession. [...] General financial assistance amount Insured paents: Insured paents shall have a discount applied to their out-of-pocket expenses. • For insured paents whose household income is at or below 250% of FPL, we will waive (i.e., 100% discount) all out-of-pocket costs for emergency and medically necessary services rendered (i.e., the care is free). [...] Uninsured paents: Uninsured paents who are eligible for financial assistance shall have a discount applied to the amount generally billed for the emergency and medically necessary services rendered. [...] If the paent connues to owe a balance aer financial assistance has been applied, North Country Hospital or a medical debt collector seeking payment for that medical debt, shall offer a payment plan that does not exceed five percent of the paent’s gross monthly household income. [...] Extenuang Circumstances North Country Hospital acknowledges that extenuang circumstances may exist in which a paent does not sasfy the criteria for financial assistance detailed in this policy, yet the paent is unable to pay for emergency or medically necessary healthcare services received or needed. [...] A paent or hospital staff may request a waiver of the financial assistance eligibility test outlined in this policy due to an unusual or unancipated circumstance which warrants special consideraon. [...] All oral or writen communicaon atempts by a medical creditor or a medical debt collector, including the Financial Navigators and Billing Office, North Country Hospital, to collect a medical debt arising from health care services delivered at this facility shall include informaon about our financial assistance policy.