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Patients

Financial Assistance Policy

The Carroll County Memorial Hospital Financial Assistance Policy (FAP) exists to provide eligible patients or other responsible parties partially or fully discounted emergent or medically- necessary care. Patients or financially responsible parties that are seeking financial assistance must apply through an application process.

Eligible Services

Emergency and/or medically necessary healthcare services provided by Carroll County Memorial Hospital and associated primary care clinics.

Eligible Patients

Patients receiving eligible services, who submit a completed Financial Assistance (FA) application (including related documentation and information), and who are determined eligible for FA by Carroll County Memorial Hospital Patient Advocate.

How to Apply

FA applications may be obtained/ completed/ submitted as follows:

  • Obtain an application at any Carroll County Memorial Hospital facility registration desks or at the Patient Advocate office(s) located at CCMH.
  • Request to have an application mailed to you or if you have any questions call (660) 542-1695 ext 3013
  • Request an application by mail at Carroll County Memorial Hospital, 1502 N Jefferson, Carrollton, MO 64633
  • Download an application here
 

Determination of Financial Assistance Eligibility

Generally, patients are eligible for financial assistance based on their income level and assets. Patients or financially responsible parties with family income of 100%- 200% of federal poverty level or less may be eligible for a discount up to 100%. Patients or financially responsible parties with family income over 200% - 300% of the federal poverty level may be eligible for a discount from 60%- 90%.

Eligible patients will not be charged more, for emergency or other medically necessary care, than the Amount Generally Billed (AGB), based on Medicare fee-for-service rates.

If you have any questions please call the Patient Advocate at Carroll County Memorial Hospital at (660) 542-1695 ext 3013.

Carroll County Memorial Hospital Financial Assistance Policy

Created/Revised on 05/19/2016