Financial Assistance Policy
Our policy ensures we meet the health needs of individuals within the communities we serve regardless of their ability to pay.
Download the Policy
Financial Assistance Policy - Plain Language Summary
Our policy ensures we meet the health needs of individuals within the communities we serve regardless of their ability to pay. A PDF file is available for you to download.
If payment of your healthcare expenses could create a financial hardship for you, you may qualify for charitable care, also referred to as charity care — the free or discounted medical care provided to low-income, uninsured or underinsured patients. Our Financial Assistance Program is designed to provide eligible patients full or partial discounts on their bills for emergency or medically necessary healthcare. This is a summary of Concord Hospital’s Financial Assistance Policy and the financial assistance application process. Applications can be obtained online or by visiting or calling our Financial Counseling Office.
- The program provides free care for those who have tried all other payment options (e.g., Medicare, Medicaid, The Health Insurance Marketplace) and:
- Have a household income at or below 225 percent of the U.S. Federal Poverty Guidelines;
- Have submitted a properly completed financial assistance application along with the required documentation.
This reduction applies to uninsured and insured patients who owe balances after insurance payments have been made.
- The program also includes catastrophic assistance for uninsured patients with household income between 225 percent and 500 percent of the U.S. Federal Poverty Guidelines who have experienced a medical hardship and owe large medical bills.
- There are certain services not eligible for financial assistance, such as cosmetic services, reproductive medicine or elective non-covered services as specified by Medicare and other third-party coverage guidelines.
- No person eligible for financial assistance will be charged more for care than amounts generally billed to individuals who have insurance covering emergency or other medically-necessary care.
Accessing & Requesting Financial Assistance Information
Besides accessing information about our Financial Assistance Program on our website, you can also access it in the following ways:
- Request the information in writing by USPS mail or by visiting a Concord Hospital Financial Counselor at 250 Pleasant Street, Concord, NH 03301;
- Request the information directly by calling (603) 227-7101 or sending an email request to email@example.com;
- Request a financial assistance application at any check-in or registration area at any of our locations.
How to Apply
- Complete a financial assistance application and submit it along with the following:
- Complete a copy of your most recent Federal Income Tax Return and all schedules. Include copies of last year's W-2 forms;
- Copies of the three most recent, paycheck stubs or a statement from the employer;
- Copy of your most recent bank statement (e.g., savings, checking, money market, IRA, 401K, etc.);
- Copies of unemployment, disability compensation benefits statements;
- Copies of social security or pension benefit income;
- Copy of food stamp allocation;
- Copies of government assistance notices (including the Department of Health & Human Services).
If you do not have all of these documents call (603) 227-7101 and speak with one of our financial counselors.
Decision & Notification
Every effort is made to finalize the decision after receipt of a complete application. Decisions are reviewed and approved by either a supervisor or a director. Notification of a decision is sent in writing.
Concord Hospital will not discriminate in the determination of financial assistance eligibility on the basis of race, color, ethnic origin, sexual orientation, marital status, creed, age, sex or disability.
Availability of Translations
Our financial assistance policy, application form and plain language summary can be offered in English and Spanish or any other language upon request. For more information, please call (603) 227-7101.