FINANCIAL ASSISTANCE
2020 POVERTY GUIDELINES
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 Hospital’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.
Persons in Household
Poverty Income Guideline
1
$12,760
2
$17,240
3
$21,720
4
$26,200
5
$30,680
6
$35,160
7
$39,640
8
$44,120
For families/households with more than 8 persons add $4,480 for each additional person.
View our Plain Language Summary of the policy in the following downloadable/printable documents:
El Programa de Atención Comunitaria
View a copy of the full policy in the following downloadable/printable documents:
PA-01 Community Care Program, Financial Assistance
PA-01 Programa de Atención a la Comunidad Asistencia Financiera
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 Financial Services 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 Financial Services Office
333 East Second Street
Richland Center, WI 53581
Community Care Program Application
Solicitud del Programa de Atencion a la Comunidad
Patient Financial Services Office
Call (608) 647-1819
Payment Plans – Rural Health Clinics
Individuals may request to establish a payment plan to meet their financial obligation. You may not combine your Clinic and Hospital payment plans. The Richland Hospital, Inc. offers the following payment plan.
Payment Plans – Hospital
The Richland Hospital, Inc. recognizes that individuals may not always have the financial ability to make a payment in full on an account. We are committed to providing financial assistance in a responsible manner and will balance an individuals’ need with our broader fiscal responsibilities. An individual may request financial assistance accordingly, to meet their obligations.
Richland Hospital payment plans are now established and managed by HELP Financial, Inc. Terms of each payment plan are defined by HELP Financial. If you already have a payment plan established with HELP Financial, you may add to it with appropriate arrangements. Payment plans for the Clinic and Hospital may not be combined. Payment plans are interest free for the first 12 months. Payment plans which extend beyond 12 months, an interest rate of 8% will be applied by and are payable to HELP Financial.
Richland Hospital Patient Financial Services Department personnel may assist in the process by request.
Payment plans may be requested by calling HELP Financial at:
OR online at the HELP Financial website at this link:
All payments are made to HELP Financial, Inc.
Checks must be made payable to HELP Financial, Inc.
For more information, please review this HELP Financial, Inc. brochure:
HELP FINANCIAL BROCHURE
Additional Information
The Richland Hospital’s Credit and Collection Policy is available at the following link:
PA-05 Credit and Collections Policy/Placement for Collections
PA-05 Políticas y Procedimientos Contables del Paciente
For more information regarding our financial assistance program or assistance in applying for the program, please call 608 647-1819 and ask to speak to a Financial Counselor.
For families/households with more than 8 persons add $4,480 for each additional person.
View our Plain Language Summary of the policy in the following downloadable/printable documents:
El Programa de Atención
Comunitaria
View a copy of the full policy in the following downloadable/printable documents:
PA-01 Community Care Program,
Financial Assistance
PA-01 Programa de Atención
a la Comunidad
Asistencia Financiera
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 Financial Services 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 Financial Services Office
333 East Second Street
Richland Center, WI 53581
Community Care
Program Application
Solicitud del Programa
de Atencion a la Comunidad
Patient Financial Services Office
Call (608) 647-1819
Payment Plans – Rural Health Clinics
Individuals may request to establish a payment plan to meet their financial obligation. You may not combine your Clinic and Hospital payment plans. The Richland Hospital, Inc. offers the following payment plan.
Payment Plans – Hospital
The Richland Hospital, Inc. recognizes that individuals may not always have the financial ability to make a payment in full on an account. We are committed to providing financial assistance in a responsible manner and will balance an individuals’ need with our broader fiscal responsibilities. An individual may request financial assistance accordingly, to meet their obligations.
Richland Hospital payment plans are now established and managed by HELP Financial, Inc. Terms of each payment plan are defined by HELP Financial. If you already have a payment plan established with HELP Financial, you may add to it with appropriate arrangements. Payment plans for the Clinic and Hospital may not be combined. Payment plans are interest free for the first 12 months. Payment plans which extend beyond 12 months, an interest rate of 8% will be applied by and are payable to HELP Financial.
Richland Hospital Patient Financial Services Department personnel may assist in the process by request.
Payment plans may be requested by calling HELP Financial at:
OR online at the HELP Financial website at this link:
All payments are made to HELP Financial, Inc.
Checks must be made payable to HELP Financial, Inc.
For more information, please review this HELP Financial, Inc. brochure:
HELP FINANCIAL BROCHURE
Additional Information
The Richland Hospital’s Credit and Collection Policy is available at the following link:
PA-05 Credit and Collections
Policy/Placement for Collections
PA-05 Políticas y Procedimientos
Contables del Paciente
For more information regarding our financial assistance program or assistance in applying for the program, please call 608 647-1819 and ask to speak to a Financial Counselor.
