Policy on Financial Assistance
Our policy ensures we meet the health needs of individuals within the communities we serve regardless of their ability to pay.
Read the Policy
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. Working with one of our financial counselors is the first step toward finding out if you may be eligible for financial assistance. Applications can be obtained online or by visiting or calling our Financial Counseling Office.
- Before any financial assistance is granted, you must have already exhausted all other sources of payment including insurance, public assistance, litigation, or third-party liability
- Family income, in relation to federal poverty guidelines
- Assets (e.g. home, bank account, and stocks)
- Any additional financial hardship
- You must be receiving non-elective, medically necessary care, and you must live within our primary service area
How to Apply
- Call (603) 227-7101 or email firstname.lastname@example.org. A financial counselor will advise you and investigate other sources that might provide financial assistance.
- 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 contact 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.