GRANT MEMORIAL HOSPITAL
PLAIN LANGUAGE SUMMARY
OF FINANCIAL ASSISTANCE POLICY
GMH is committed to offering financial assistance to people who have health care needs and are not able to pay for care. You may be able to get financial assistance if you are uninsured (limited circumstances) or underinsured, not eligible for a government program, do not quality for governmental assistance (for example Medicare or Medicaid), or who are approved for Medicaid but the specific medically necessary service is considered non‐covered by Medical Assistance. GMH strives to make sure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. This is a summary of the GMH Financial Assistance Policy (FAP)
Availability of Financial Assistance
You may be able to receive financial assistance if you are uninsured (limited circumstances) or underinsured, or if it would be a financial hardship to pay in full the expected out of pocket expenses for services at GMH. Please note that there are certain service exclusions that are not typically eligible for financial assistance, including, but not limited to cosmetic services, sterilization reversal, Cardiac Rehab Phase III and other services.
Financial assistance is determined by total household income based on the Federal Poverty Level (FPL) and asset levels. If you and/or the responsible party’s income combined are at or below 200% of the federal poverty guidelines, you may have no responsibility for the care given by GMH. No person eligible for financial assistance under the FAP will be charged more for emergency or other medically necessary care than amounts generally billed to individuals who have insurance covering such care. If you have sufficient insurance coverage of assets available to pay for your care, you may not be eligible for financial assistance. Please refer to the full policy for the complete explanation and details.
Where to Find Information
There are many ways to find information about the FAP application process, or get copies of the FAP or FAP application form. To apply for financial assistance you may:
- Download the information online at www.grantmemorial.com
- Request the information in writing by mail or by visiting our Patient Financial Counselor at GMH, 117 Hospital Drive, Petersburg, WV 26847
Availability of Translations
The Financial Assistance policy, application form, and the plain language summary can be offered in English and Spanish. For information about GMH’s Financial Assistance Program and translation services, please call for a representative at 1‐800‐571‐4853.
How to Apply
The application process involves filling out the financial assistance form and submitting the form along with the support documents to GMH for processing. You may also apply in person by visiting the Financial Counselor at the address listed below. Financial assistance applications are to be submitted to the following office:
Financial Assistance Program
P.O. Box 1019
117 Hospital Drive
Petersburg, WV 26847