2600 Ottawa Road | PO Box 360 | Neodesha, KS 66756 | 620-325-2611
OUR FINANCIAL ASSISTANCE PROGRAM
Medical expenses can seem overwhelming, but you don't have to face them alone. If you need assistance paying your medical bills, Wilson Medical Center may be able to help. If you qualify for financial assistance, you can get help for your full or partial bill. (This does not include bad debt.)
WHO CAN QUALIFY?Patients who do not have insurance may qualify based on their monthly or annual income and their family size. Patients having insurance may also qualify for assistance for the portion of their bill that is not covered by insurance, including deductibles, coinsurance, and non-covered services.
The determination of full or partial financial assistance will be based on the patient's ability to pay and will not be lessened on the basis of age, sex, race, creed, disability, sexual orientation or national origin.
WHAT IS THE FIRST STEP?An application (known as the Financial Responsibility Statement) is used by patients to apply for financial assistance from the hospital. The hospital Patient Account Manager will assist you with this process by mailing you or your authorized representative a letter explaining the application process and an application form.
WE'LL NEED YOUR HELPThe Financial Responsibility Statement must be filled out completely with proof of the patient's financial information that is requested on the application. The patient's household income and number in household are compared to the Federal poverty guidelines to determine if the patient qualifies for a write off or the reduced monthly payment program.
Proof of financial information is needed. You may choose to provide copies of pay stubs for the past 3 months for all employed household members. Another option is to provide a copy of last year's federal income tax return with all attachments for all household members that filed. Any other income information must also be provided such as a benefit letter or copy of a check from the payer. Unfortunately, if applications are received without proof of finances, a letter will be sent requesting this information and processing of your application will be delayed.
WHAT HAPPENS WHEN YOUR APPLICATION AND ALL REQUESTED INFORMATION IS RECEIVED?Your application will be processed by the Patient Account Manager and officially approved by the Chief Financial Officer. Please give them 14 days to complete the process.
If you qualify for assistance, you will be notified verbally or by letter of the type of assistance you qualify for.
If you do not qualify, you will be notified verbally or by letter.
OUR COMMITMENT TO YOUPreservation of individual dignity and confidentiality shall be maintained for all who apply for this program. No information obtained in the application may be released unless the patient gives permission for such release.
Financial Assistance Instructions
Financial Assistance Policy
Financial Assistance Application
Financial Assistance Formula