Financial Assistance Program
The mission of Granville Health System is to provide the community we serve with the very best health care delivered with compassion and pride. In doing so, we also recognize that medical care is sometimes necessary for patients who are unable to pay for these services.
Therefore a Financial Assistance Program has been established to assist qualifying patients in handling expenses for unexpected medically necessary services. Based on information received you may qualify for all or part of your medical expenses to be written off.
The Financial Assistance Form, along with the required documentation listed below, must be completed.
If You Are Working please provide:
• Three of your most current pay stubs
• If you are married, (3) stubs from your spouse also
• Copy of last completed income tax return
• If you receive social security income provide proof from one of the following sources:
- Recent social security benefit statement
- Copy of your bank statement if your check is direct deposit
- Copy of your Social Security Check prior to cashing.
If You Are Not Working:
• Provide a copy of your wage record
If You Are Not Working And You Are Currently Living With Family Or Friends:
• Please have the head of household write a letter to confirm your current situation.
Patients will be expected to comply and cooperate in all processes to apply for third party payer programs. Our Financial Assistance Counselors are available to assist you with these processes.
Family Gross Income – Annual gross income must be within 200% -300% of the current Federal Poverty Guidelines
• Resource limit not to exceed $3,000
• Owned property will be limited to the home in which the guarantor resides as their main residence which
includes any land adjacent to the main residence
• Automobile(s) needed for transportation to work
Catastrophic Medical Expenses – If you have self pay expenses due to non-routine (catastrophic) medical expenses we will also take these expenses into consideration.
A credit report will be reviewed for current credit extensions.
Balances on accounts which do not qualify for 100% of the Financial Assistance Program may be paid in full. However in the event that payment in full is not possible a scheduled payment plan will be established.
SELF PAY DISCOUNT
Patients who do not qualify for the Financial Assistance Program and have no insurance may receive a 20% discount if the complete balance is paid within 30 days of the date of the First Statement.
The Patient Financial Services Department is always here to assist you and answer any questions you may have. Please feel free to contact us and help us help you!