← Patient Financial Services


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 policy

Our cur­rent finan­cial assis­tance pol­i­cy out­lines this program. 

financial assistance application

Designed for patients who do not have the abil­i­ty to pay their hos­pi­tal bill(s).

student financial assistance application

The finan­cial assis­tance appli­ca­tion that is designed for stu­dents who are unable to pay their hos­pi­tal bill(s).