Financial Assistance


Financial Assistance Policy - Plain Language Summary


The Citizens Medical Center Financial Assistance Policy exists to provide eligible patients discounted emergent or medically-necessary hospital care. Patients seeking financial assistance must apply for the program, which is summarized below.

Eligible Services - Patients receiving eligible services must submit a Financial Assistance Questionnaire (including related documentation/information). Determination of eligibility results from a review of the submitted information by the Patient Financial Advisor, Billing Office Manager, and Chief Financial Officer. Elective care is not covered by financial assistance and is the responsibility of the patient at 100% of charges.

How To Apply - The Financial Assistance Questionnaire may be obtained, completed, and submitted as follows:

Determination of Financial Assistance Eligibility - Generally, patients are eligible for financial assistance based on their income level and assets. Patients with family income of 100% of the Federal Poverty Level or less may be eligible for a discount of 100%. Patients with family income of over 100% of the Federal Poverty Level may be eligible for a discount of either 50% or 30%. Eligible patients will not be charged more for emergency or other medically necessary care than Amounts Generally Billed (AGB) to those patients who have insurance

Financial Assistance Brochure

Providers Covered by Hospital FAP