Eligibility Criteria
Financial assistance is available to patients with:
- Total income at or below 200% of the federal poverty level
- A discounted/sliding fee schedule is available based on family size and income
- Without Medicaid or other health insurance through the Health Insurance Marketplace.
Eligible patients may have up to 100% of their charges forgiven. No one will be denied access to services based on inability to pay.
Items Needed When Applying for Financial Assistance
Patients must complete a financial assistance application and provide written verification of their gross monthly/annual family income which includes household dependents. To support the amount of income reported on your application, please provide one or more of the following items:
- W-2 statement for ALL household employment;
- Pay stubs for the past 30-day for ALL persons employed in the home prior to the date of request;
- Signed income tax return (IRS) from the most recently filed year;
- Forms denying Medicaid eligibility within the affected time period;
- Written proof that the patient’s family income is below the poverty level;
- Forms approving or denying unemployment compensation.
- Written proof that patient’s family income is below 200% of the poverty level;
- Written statements from employers or welfare agencies (denial letters).
If Approved…
If you are eligible for financial assistance and are approved, then up to 100% of your unpaid charges may be written off.
If Not Approved…
If you are not eligible for financial assistance, then Northwood Health Systems will mail you biweekly bills for services rendered. You may then either pay in full or arrange a payment plan.
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