Wakemed charity care 2025

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  1. Click ‘Get Form’ to open the wakemed charity care application in the editor.
  2. Begin by filling out the Guarantor/Patient Information section. Provide your name, Social Security number, date of birth, and account number. Indicate if the patient is deceased and attach a death certificate if applicable.
  3. Complete your address details including city, state, and zip code. Include both home and cell phone numbers, and confirm your citizenship status.
  4. In the Spouse (Parent) Information section, enter relevant details about your spouse or parent if applicable.
  5. List all household members who have received care at WakeMed. If more space is needed, add additional members on a separate sheet.
  6. Fill out the Health Insurance/Other Assistance section by indicating any assistance programs you have applied for and checking applicable insurance options.
  7. Provide Employment Status information for yourself and your spouse, detailing current and prior employers along with salary information.
  8. Complete sections regarding income sources, assets, liabilities, banking information, life insurance policies, and certification at the end of the form.

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Uncompensated care excludes other unfunded costs of care, such as underpayment from Medicaid and Medicare. AHA combines the hospitals bad debt and charity care costs to arrive at the hospitals total costs of unreimbursed care provided to medically indigent and underinsured patients.
Aid at some hospitals is limited to patients whose income is below the federal poverty level (FPL), while at others, patients with incomes that are five or six times the FPL can receive assistance. In addition, some nonprofit hospitals may be billing patients with incomes low enough to qualify for charity care.
The Financial Assistance Program is available to North Carolina residents with a household income and assets at or below 300% of the Federal Poverty Guideline (FPG) for your family size. Meet FPG household income % for family size. Household income includes assets (bank balances, investments, etc.)
The Financial Assistance Program is available to North Carolina residents with a household income and assets at or below 300% of the Federal Poverty Guideline (FPG) for your family size. Meet FPG household income % for family size.
Sarah Avery, Duke Health This is not a merger between the two organizations. Duke Health and WakeMed will continue to operate independently apart from the collaboration and maintain their own identities.
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