Financial Assistance Availability

The Financial Assistance Policy, Financial Evaluation Form, and plain language summary are available in Spanish, French, French Creole, Portuguese and Russian.

Availability of Financial Assistance

If the patient or responsible party requests financial assistance, Memorial Healthcare System will determine if the patient or responsible party has the ability to pay. This examination, or screening, for financial assistance is free of charge. The amount of the requested financial assistance must be more than $500. Financial assistance is not available when the patient chooses to pay the “self-pay” rate that is available when the payment is made prior to service or discharge.

Patients or responsible parties will be considered for discounts:

  • Up to 100% if the total household income is less than 200% of the FPG
  • Up to 100% if the total balance due is more than 25% of the total household’s annual income
  • Up to 100% if the total household’s annual income is not more than 4 times the FPG for a family of 4
  • From 73% to 90% when the total household’s income is between 201% and 400% of the Federal Poverty Guidelines

Please refer to the full policy (PDF) for a complete explanation and details.

Review Process

The patient or responsible party has up to 120 days to provide all of the requested information. Memorial Healthcare System will then review the information and determine whether the patient or responsible party meets the financial assistance guidelines. Memorial Healthcare System will tell the patient or responsible party in writing whether or not they qualify under the Financial Assistance Policy guidelines.

If a patient or responsible party is eligible to receive financial assistance under the Financial Assistance Policy, he or she will not be charged more than the Amounts Generally Billed (AGB). At Memorial Healthcare System, the AGB is determined through the “look-back method” which calculates the average percentage of charges insurance companies pay and applies that percentage to the patient’s accounts. The calculation is available in the Financial Assistance Policy (PDF) or in the Registration areas of any of the facilities.

Please refer to the full policy (PDF) for a complete explanation of the calculation.

Physicians Offering Financial Assistance

mpglogoDoctors that are a part of our Memorial Physician Group offer financial assistance. See the full list of Memorial Physician Group doctors or when searching for a physician, look for the Memorial Physician Group logo.

View the list of physicians who offer and do not offer financial assistance (PDF).

Other Languages

The Financial Assistance Policy, Financial Evaluation Form, and this plain language summary are available in several other languages.

Plain Language Summary

Full Policy