Ivinson Memorial Hospital financial assistance program is designed to assist patients who may not have the ability to pay their hospital bill(s). The level of assistance provided is based on a review of an individual’s economic condition which includes income level and assets held.
Upon request, an application and a list of required financial documentation will be provided. This information is necessary to determine the patient’s ability to pay. Both the completed application and all required financial documentation must be returned in order to be considered for financial assistance. Please be aware of the due date on your application.
Accounts must be in good standing. Therefore, any accounts at collection status more than six months are not eligible for financial assistance. Accounts for outpatient services, quality of life procedures, elective procedures or any other non-emergent procedures are only eligible for our standard payment plans. These accounts do not qualify for financial assistance. Payments are required to keep your account(s) current during the application process. Please include a payment with your returned application as a sign of good faith. NOTE: Any account under $500.00 will NOT qualify for financial assistance.
The application is only for charges with Ivinson Memorial Hospital. The application does NOT cover Advanced Medical Imaging, Anesthesia services, any billing from a doctor or surgeon or any entity other than Ivinson Memorial Hospital.
You may contact our Financial Counselor or our receptionist to request an application packet. We will need to verify your status as student or non-student to ensure the correct information for required documentation is included.
financial assistance application
Designed for patients who do not have the ability to pay their hospital bill(s).