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PLAIN LANGUAGE SUMMARY OF FINANCIAL ASSISTANCE POLICY



Eligibility:
Eligibility for charity will be considered for those individuals who are uninsured, under-insured, and who have incomes up to 250% of Federal Poverty Level and who are unable to pay for their medically necessary or emergent care, based upon a determination of financial need or catastrophic circumstances.

Where to find Policy and Application:
The HCH policy and application can be downloaded directly from www.hch-ks.org. The FAP and application are available at admissions desks and throughout the facility. The FAP and application can also be obtained free through the mail by contacting the Patient Engagement Team at 785-742-2131.

How to get information regarding the FAP and application process:
Please contact the Patient Engagement Team by calling 785-742-2131 or by stopping by the business office at the main entrance of the hospital at 300 Utah Street Hiawatha, Kansas.

Translations:
A Spanish version of the FAP and the plain language summary are available on request or online.

Anyone who qualifies for assistance under the HCH Financial Assistance Policy will not be charged more than the amount generally billed by Medicare, and may qualify for a 100% discount on charges owed by the qualified patient.

Below you will find additional information on our financial assistance policy as well as our billing collections policy and the application for financial assistance:

Financial Assistance Policy
Financial Assistance Policy - Plain Language Summary
Politica de Asistencia Financiera
Billing Collections Policy

Charity Care Application

If you have any questions regarding our application process please feel free to contact:

Financial Counselor
Patient Engagement Team
785-742-2131