financial assistance
Rome Memorial Hospital recognizes that there are times when patients will
have difficulty paying for the services provided. Rome Memorial Hospital’s
financial assistance program provides discounts to qualifying individuals
based on your income. In addition, we can help you apply for free or
low-cost insurance if you qualify. Just contact our Business Office at
315-338-7261 for free, confidential assistance.
Who qualifies for a discount?
Financial Assistance is available for patients with limited incomes and are
underinsured or have no health insurance. Everyone who needs emergency
services can receive care and get a discount if they meet the requirements.
Everyone can also get a discount on non-emergency, medically necessary
services at Rome Memorial Hospital if they meet the requirements. You
cannot be denied medically necessary care because you need financial
assistance.
You may apply for a discount regardless of
residency or immigration status.
What are the income limits?
The amount of the discount varies based on your income and the size of your
family.
Rome Memorial Hospital discounts patient accounts up to
100% depending upon family income in comparison to the federal poverty
level. Discounts are based upon the Blue
Cross rate. Rome Memorial Hospital offers
discounts to the uninsured/underinsured whose income is up to 300% of the
federal poverty level.
|
If
your family size is
|
Maximum annual household income to qualify for
Medicaid
|
Maximum annual household income to qualify for DISCOUNTED care
|
| 1 |
$10,830 |
$32,490 |
| 2 |
$14,570 |
$43,710 |
| 3 |
$18,310 |
$57,930 |
| 4 |
$22,050 |
$66,150 |
| 5 |
$25,790 |
$77,370 |
The 2009 Federal Poverty
Level Guidelines were established by the Department of Health and Human
Services as printed in the Federal Register as of January 23, 2009.
What if I do not meet the income limits?
Even if patients don’t qualify for financial assistance, Rome Memorial
Hospital will work with you to develop an extended
payment plan.
When people are having difficulties paying their
bills, the most important thing for you to do is contact the Business Office
to explore your options.
Can someone explain the discount? Can someone help me apply?
Yes, free, confidential help is available. Call the Business Office at
315-338-7261 for free, confidential assistance.
If you do not speak English, someone will help
you in your own language. Rome Memorial Hospital also hosts
enrollment representatives who can help you enroll in free or low-cost
insurance programs, such as Medicaid, Child Health Plus and Family Health
Plus.
For an appointment please call:
- Fidelis Care NY
373-1214
- Mohawk Valley Perinatal Network
732-4657
- Americhoice United Healthcare
1-800-339-5380 x-5892
What do I need to apply for a discount?
To apply for a discount, you will need to provide proof of income, such as
copy of pension and/or Social Security check, paystub or W-2 form.
If you can not provide any of these, you may
still be able to apply for financial assistance.
What services are covered?
All medically necessary services provided by Rome Memorial Hospital are
covered by the discount. This includes outpatient services, emergency care,
and inpatient admissions.
Charges from
private doctors (such as Rome Emergency Services, Rome Radiology
Associates, Rome Anesthesiology, or your own physician)
who
provide services in the hospital may not be covered. You should talk to
private doctors to see if they offer a discount or payment plan.
How much do I have to pay?
If your household income is at or below the poverty
line, you will be responsible for $0-$150.
Uninsured/underinsured patients who earn up to
300% of the federal poverty level are eligible for discounts.
The Business Office will give you the details
about your specific discount(s) once your application is
processed.
How do I get the discount?
You have to fill out the
application
form. As soon as we have proof of your income, we can process your
application for a discount according to your income level.
You can apply for a discount before you have an appointment, when you
come to the hospital to get care, or when the bill comes in the mail.
Send the completed form to:
Rome Memorial Hospital
Business Office
155 W. Dominick St.
Rome, NY 13440.
You have up to 90 days after receiving services to submit the
application.
How will I know if I was approved for the discount?
Rome Memorial Hospital will send you a letter within 30 days after
completion and submission of documentation, telling you if you have been
approved and the level of discount received.
What if I receive a bill while I’m waiting to hear if I can get a discount?
You cannot be required to pay a hospital bill while your application for a
discount is being considered. If your application is turned down, the
hospital must tell you why in writing and must provide you with a way to
appeal this decision to a higher level within the hospital.
What if I have a problem I cannot resolve with the hospital?
You may call the New York State Department of Health complaint hotline at
1-800-804-5447.
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