Financial Assistance at Cottage Hospital

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. Criteria Categories for Financial Assistance

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.

Exclusions for Eligibility 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. Financial Assistance Programs available at Cottage Hospital 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).

How to Apply for Financial Assistance 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

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. Notification 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. Making payments 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 Contact Cottage Hospital’s Patient Financial Counselor is available Monday-Friday 8-4 at (603) 747-9220 or ksousa@cottagehospital.org .