Financial Assistance Program

Financial Assistance Program and Billing Policies

Vernon Memorial Healthcare ensures that our patients are treated with compassion in regard to payment of their bills. Vernon Memorial Healthcare accepts most major health insurance plans. We provide various levels of financial assistance to those who are unable to pay for health care services. Financial assistance is available to individuals who do not have the ability to pay their full obligation as determined by our qualification criteria. The amount of the aid will take into account each individual’s ability to contribute to the cost of his or her care. 

[Download] Vernon Memorial Healthcare Financial Assistance Policy

[Download] About the Financial Assistance Program(Plain Language Summary)

[Download] Financial Assistance Application Form

[Download] Release of Protected Health Information

[Download] Amounts Generally Billed Statement

[Download] Language Translation Statement

 

Spanish/Español

[Download] Declaración Para la Traducción de Idiomas [Español]

[Download] Política de Asistencia Financiera [Español]

[Download] Solicitud de asistencia financiera [Español]

[Download] Declaración de Amounts Generally Billed (AGB) [Español]

[Download] Sobre la asistencia financiera en Vernon Memorial Healthcare [Español]

 

German/Deutsche

[Download] Erklärung zur Sprachübersetzung [Deutsche]

[Download] Antrag Auf Finanzielle Unterstützung [Deutsche]

[Download] Finanzhilfepolitik [Deutsche]

[Download] Erklärung zu den Amounts Generally Billed [Deutsche]