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 Hospitals
in New Hampshire work hard to make quality health care available,
affordable, and accessible to all, regardless of ability to pay.
Cottage Hospital offers many financial assistance and referral programs
to ensure that cost will not be a barrier to anyone in our community
getting the health care services they need. If payment of your health
care expenses could create a financial hardship for you, our staff will
work with you to apply for financial assistance for your medical needs.
Information you provide is confidential and is only reviewed by staff
processing your application.
Even if you do not feel you qualify for financial assistance, call us
anyway to receive an application. There are many factors taken into
consideration when determining eligibility. We also may be able to
connect you with other resources for which you may qualify.
As part of the financial counseling application process, the hospital
will assess your potential eligibility for health insurance coverage
through federal or state programs such as New Hampshire Medicaid. If it
is determined that you may be eligible for one of these programs, the
hospital will assist you in the application process. You will be
required to supply the financial or medical documentation that is
necessary to secure such insurance coverage.
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- Family income, in relation to
federal poverty guidelines
- Assets (e.g. home, bank account,
and stocks)
- Any additional financial hardship
- You must be receiving medically
necessary care.
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Cosmetic procedures and infertility services are not eligible for
financial assistance. All other elective or non-emergent services are
covered at the discretion of the health provider or hospital. You
should ask if the service will be covered before receiving the service.
Cottage Hospital has developed a charity care program called Cottage Care to assist a
patient with their need for healthcare services. Patients with limited
financial resources may apply for ‘Cottage Care’.
To qualify, candidates must provide proof of their total assets, per
family member savings, certificates of deposit, checking
accounts, and incomes.
Cottage Hospital also allows patients to setup Time Pay Plans. Payment
plans are generally negotiated to pay the account balance in full
within 12-months. However, unusual circumstances or high balances may
be negotiated with our Patient Financial Counselor or Business Office
Manager.
Cottage Hospital also participates in NH Health Access Network (click here to read
more about this program).
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 Please
call our Patient Financial Counselor at (603) 747-9220. A Patient
Financial Counselor will advise and assist you in your investigation of
other possible sources of financial assistance.
Complete a Cottage
Care
application or NHHAN
application. You can print it from our web site, pick it up
at Cottage Hospital's reception desk, Woodsville Health
Services,
Monroe Health Services, or call us at (603) 747-9220 to request that
one be mailed to you.
Submit the application with the following documents: |
- Complete copy of your most recent
Federal Income Tax Return and all schedules. Include copies of last
year’s W-2 forms.
- Copies of the three most recent,
paycheck stubs or a statement from the employer
- Copies of three most recent bank
statements (e.g., savings, checking, money market, IRA, 401K, etc.)
- Copies of unemployment, disability
compensation benefits statements
- Copies of social security or
pension benefits income
- Copy of food stamp allocation
- Copies of government assistance
notices, such as Social Security disability and Medicaid
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Please submit the above documents through
postal service mail or in person; do not email copies of your documents
as we cannot guarantee the security of your personal information.
Your
application will be processed within 10-business days of
receipt. If approved, you will
receive a letter and a
business card in the mail with the determination.
You may qualify for both the NHHAN
and
Cottage Care programs at differing percentages.
The front of your card will state
the NHHAN percentage and the back of
the card will state the Cottage Care percentage.
This card will also list your
expiration date. As
you approach the expiration date of your
card, you will need to re-apply to the program.
If
an application for Cottage Care is denied, the patient
has the right to request a review by the Business Office Manager (BOM)
and the
Chief Financial Officer (CFO). The
appeal must be written and submitted with any additional information
that was
not submitted with the original application.The BOM or CFO will make a
final
decision within 30-days of receipt of
the written appeal.
The Cottage
Care plan is honored only at Cottage Hospital, Woodsville Health
Services, and
Monroe Health Services for services provided by Cottage Hospital
staff. It does not include tests performed at outside
labs, or radiology readings performed by non-Cottage Hospital staff.
We know that health care costs can come up unexpectedly. Whether you
are insured or uninsured, whether or not you qualify for financial
assistance — we understand that you may have difficulty
paying your healthcare costs in full at the time of service or in a
lump sum. Cottage Hospital is happy to work with any patient to set up
a payment
plans. Payment plans are generally negotiated to pay the account
balance in full within 12-months. However, payment plans for
unusual circumstamces or high balances may be negotiated with our
Patient Financial Counselor or Business Office Manager.
Cottage Hospital offers a 10% prompt pay discount, when payment is
received within the first 30-days of the billing cycle. And payments
may be made with the following credit cards.
| VISA |
Master Card |
Discover Card |
Cottage Hospital’s Patient Financial Counselor is available
Monday-Friday 8-4 at (603) 747-9113 or kclark@cottagehospital.org. |
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