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GRANT MEMORIAL HOSPITAL

PLAIN LANGUAGE SUMMARY

OF FINANCIAL ASSISTANCE POLICY   

Overview
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.  

Eligibility Requirements
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
  • Request the information directly by calling 1‐304‐257‐5815 Ext 2161 or email:  This email address is being protected from spambots. You need JavaScript enabled to view it.        

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  
GMH
P.O. Box 1019
117 Hospital Drive
Petersburg, WV 26847