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Moundview Memorial Hospital & Clinics (MMH&C's) Financial Assistance Policy provides emergency and medically necessary care at discounted rates for persons who meet certain eligibility requirements in accordance with applicable federal and state laws.  Medical services provided by other health care facilities or non-MMH&C physicians are excluded.

If the medical service provided is covered by Medicare, Medicaid, or other health insurance, it is not covered under this policy.  If you are unable to pay your insurance deductibles/co-pays in full, you are encouraged to set up a payment plan at MMH&C.

Eligibility:
Eligible individuals will initially be charged the usual and customary fees for the medical services they receive.  Discounted rates will be billed to individuals after their eligibility has been determined.  Please see the "Frequently Asked Questions" and "Instructions When Applying for Financial Assistance" links below for further details on eligibility requirements, including which services are eligible for financial assistance.

The following chart indicates the discounted rates for this fiscal year based on poverty level and services provided.

Poverty Level Inpatient (per diem) Swing Bed (per diem) Ancillary (% of charges) Family Clinic (per visit)
<100% $ 460.00 $ 480.00 8% $ 25.00
125% $ 920.00 $ 960.00 17% $ 37.50
150% $1,380.00 $1,440.00 25% $ 50.00
175% $1,840.00 $1,920.00 34% $ 62.50
200% $2,300.00 $2,400.00 42% $156.23

 

Financial Assistance Cap:
MMH&C will fund $500,000 in financial assistance per fiscal year (July 1-June 30).  If this amount is exceeded, MMH&C may choose to add funding to this amount or to fund services on a case by case basis.  Services received in the emergency department, under the Emergency Medical Treatment and Active Labor Act, may be funded on a case by case basis if the maximum yearly limit has been reached.

Application:
You must complete an application and be deemed eligible within 150 days (four months) after MMH&C provides an initial billing statement for the date(s) of service.  If you fail to submit an application within 150 days, you are responsible for the entire cost of the services provided even if eligibility requirements would have been met.

Frequently Asked Questions

Instructions When Applying for Financial Assistance

Financial Assistance Application