Community Care Financial Assistance

When people find themselves without health insurance or with insurance coverage that transfers payment responsibility for deductibles or co-payments at a level that cannot be financially managed, The Richland Hospital, Inc. can help. Patients that meet specific financial eligibility requirements can receive help through The Richland Hopsital’s financial assistance program. Information is provided below on the various options available.   

Community Care Program

The Richland Hospital Inc.’s Community Care Program offers discounted or free care to eligible patients. The program was created to ensure that all members of the communities we serve are able to access essential medical care, regardless of what they can afford to pay. Discounts offered under this program are made available without consideration of race, color, religion, sex, age, national origin, citizenship, veteran status, marital status, handicap/disability or sexual orientation. All patients may apply for Community Care.

Patients with family income that is at or below 150% of the Federal Poverty Guidelines may be eligible for a 100% discount. Patients with a family income between 151% to 300% of the Federal Poverty Guidelines may be eligible for a partial discount and/or a reduced payment plan on any remaining balance.

2017 Poverty

 

Persons in Family/Household Poverty Guideline/Income
1 $12,060
2 $16,240
3 $20,420
4 $24,600
5 $28,780
6 $32,960
7 $37,140
8 $41,320

For families/households with more than 8 persons add $4,180 for each additional person.

View our Plain Language Summary of the policy in the following downloadable/printable documents:

View a copy of the full policy in the following downloadable/printable documents:

Community Care is not an insurance program or an entitlement program, and is not meant to replace benefits that are, or could be, received from government-supported programs. Applicants are expected to exhaust all other payment sources as a condition of approval. For example, you might be eligible for Medicaid or Medicare and you will be required to apply for those programs before receiving a discount under Community Care. You will be asked to provide verification of your denial for any program for which you may be eligible. Community Care program discounts do not apply to elective services.

Applying for Community Care

Applications for Community Care can be obtained by contacting the Patient Accounting Department at The Richland Hospital, Inc. or click on the link below, print and complete the Community Care Program application. You may mail or deliver the application and the supporting documentation to:

The Richland Hospital, Inc.
Attn: Patient Accounting Office
333 East Second Street
Richland Center, WI 53581

Community Care Program Application

Solicitud del Programa de Atencion a la Comunidad

 

Patient Accounting Office
(608) 647-6321

Payment Plans

Individuals may request to establish a payment plan to meet their financial obligation. The Richland Hospital, Inc. offers the following payment plans.

Standard Payment Plan

Patient may establish a payment plan based on an agreed upon payment schedule that follows the minimum monthly payment limits and terms as listed below.

Total Patient Balance Repayment Term

  • Up to $100.00 Due within thirty (30) days
  • $100.01 to $300.00 Due in even payments across three (3) months
  • $300.01 to $1,200.00 Up to twelve (12) months to pay with a signed, formal payment guarantee on file and minimum monthly payments of $100.00
  • $1,200.01 to $1,800.00 Up to twelve (12) months to pay with a signed, formal payment guarantee on file and monthly payment of $150.00
  • $1,800.01 and up Establish repayment within twelve (12) months with a signed, formal payment guarantee on file

Extended Payment Plans

An individual may be eligible for an Extended Payment Plan that provides for repayment limits at less than the above Standard Payment Plan criteria by completing an Application for Financial Assistance and submitting that document along with necessary supporting materials to the Patient Accounting Department.

Community Care Approved Accounts

For patients meeting the eligibility requirements for the Community Care program but have a balance remaining, a $50 minimum payment may be approved.

Additional Information

The Richland Hospital’s Credit and Collection Policy is available at the following link:

For more information regarding our financial assistance program or assistance in applying for the program, please call 608 647-6321 and ask to speak to a Financial Counselor.