FinancialAssistance

Decatur Morgan Hospital is committed to providing quality health care that improves the health of those we serve. One of the ways we fulfil this mission is to provide financial assistance to those members of the community in need. Our Financial Assistance Program may be able to assist with expenses for your care.

How can I qualify?

To find out if you qualify for financial assistance, please complete the Application Form and attach documents that prove income or other available resources. If you need help completing the application, financial counselors are available by calling (256) 973-4688, Monday–Friday, 8 a.m. - 4 p.m. All inquiries are confidential.

How do I apply?

Print and complete the application form and mail it to the Financial Counselors at the following Address:

Decatur Morgan Hospital
Attention: Financial Counselor
P.O. Box 2239
Decatur, Al 35609-2239

Instructions

When completing the Application Form, be sure to include documents that verify your income for yourself and for your spouse (if applicable).

Examples of documentation used to verify eligibility include pay stubs, tax returns forms and bank statements. Additional forms of verification may be required.

Verification of Income

  • If you are currently employed, please provide verification of gross income for the last two months. Verification can be a check stub or a letter from your employer on company letterhead.
  • If you are self-employed, please provide a complete copy of the prior tax year income tax return, including schedule C and all forms.
  • If you are unemployed and drawing unemployment benefits, please provide verification of the amount you receive. Verification can be your unemployment benefit approval letter.
  • If you are unemployed and have no income, please provide three written statements from relatives or friends that can verify your circumstances.
  • If you are collecting Social Security, SSI, Social Security Disability or Veteran or Military Pension, please provide verification of income. Verification can be a copy of your most recent check stub or a letter from the government showing the amount you are receiving. If your minor children also receive a check, please provide verification of their income as well.
  • If you receive Food Stamps, AFDC (Aid for Dependent Children), or FA (State-provided Family Assistance), please provide verification of the assistance. Verification can be your approval letter outlining your proof of eligibility.
  • If you receive child support or alimony or receive assistance from your children's other parent (not living in the household), please provide verification of that income source. Verification can be a copy of your child support order or divorce decree.
  • If you are separated and/or going through a divorce, please provide legal proof of separation.
  • If your monthly expenses exceed your income, please provide verification of how your monthly expenses are being satisfied. Verification can be letters of financial support from your family, friends, church or other organizations. If you are using credit cards, cash advances or loans to satisfy your monthly expenses, please provide copies of the most recent statement of those items.

Verification of Assets

  • Please provide copies of your complete bank statements for the last two months (including all pages of all checking, savings or certificates of deposits). If your bank account has been closed, please provide a letter from the bank stating your account has been closed.
  • Other assets, such as real estate (other than your primary residence), rental income or investment equity will be verified during the financial application process.

Eligibility

We will determine financial assistance eligibility based upon income and the Federal Poverty Income Guidelines. Approved applications apply to Decatur Morgan Hospital accounts only.

Notification of Eligibility

Applicants will be notified by letter regarding their financial assistance application status.

Financial Assistance Policy

Patients who meet certain income criteria may qualify for financial assistance based on the below criteria:

Uninsured Patient
Financial Assistance Guidelines

Income Level (of FPL)

Discount

0-200%

100% of Medicare rate

201% - 250%

50% of Medicare rate

251%-300%

40% of Medicare rate

301%-350%

25% of Medicare rate

351%-400

15% of Medicare rate

(FPL - Federal Poverty Level)

If you receive an award of financial assistance from Decatur Morgan Hospital and the award does not cover 100% of Decatur Morgan Hospital’s charges for the services provided, a patient will not be charged more for emergency or other medically necessary care than the amount we generally bill patients that have insurance under Medicare.

Continued Collections

Please note that collections continue on your account until all required verification is received. If supporting documentation is not submitted with the financial statement and/or falsification of any portion of the application is identified, your application will be denied. We reserve the right to reverse financial assistance when information is presented indicating the patient/guarantor has the ability to pay for services and financial assistance should not have been approved.

PLEASE NOTE: The financial assistance offered under this program does not apply to physician or other professional fees billed separately from the hospital fees. For questions or assistance with the financial assistance application, please call our office at (256) 973-4688.

The application is the printer-friendly PDF format. If you cannot view the application, download the Acrobat Reader for free.

Extraordinary collection actions will be suspended during the consideration of a completed charity care application. Prior to placement with an agency, a note will be entered into the patient’s account related to charity care to suspend collection activity. If the account has been placed at the agency, the agency will be notified by telephone to suspend collection efforts until a determination is made. If a charity care determination allows for a percent reduction but leaves the patient with a self-pay balance, payment terms will be established on the basis of disposable income.