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HOSPITAL FINANCIAL ASSISTANCE PROGRAM - Lima Memorial

HOSPITAL FINANCIAL ASSISTANCE PROGRAM - Lima Memorial 2026

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The document outlines the application process for the Hospital Financial Assistance Program (HFA) at Lima Memorial, detailing eligibility criteria based on family income relative to Federal Poverty Guidelines. It emphasizes the confidentiality of provided information and the requirement for applicants to reside in specific Ohio counties. The application requires comprehensive financial details, including various income sources, and mandates proof of income and citizenship status. It also includes a section for family member information and employer history, with a warning against providing false information.

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Click ‘Get Form’ to open the HOSPITAL FINANCIAL ASSISTANCE PROGRAM application in the editor.
Begin by filling out your personal information, including your name, address, phone number, date of birth, and email. Ensure all fields are completed accurately.
Indicate your marital status and citizenship status. If applicable, provide your Social Security number and Medicaid billing number.
In the income section, list all sources of gross family income such as employment, social security, and child support. Be thorough to ensure eligibility for assistance.
Check the appropriate Ohio county you reside in from the provided list to confirm eligibility for the program.
Complete the employer information section for yourself and any guarantors over the last 12 months. This includes dates of employment.
Finally, review all entered information for accuracy before signing at the bottom of the form. Your signature confirms that all details are true to your knowledge.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What if I cant afford to go to the hospital?

docHub out to a patient advocate organization or ask for a lower bill if financial assistance isnt available. Find a patient advocate who can help. Hospitals and medical offices can sometimes lower the price. They may also offer payment plans.

How much do hospitals write off unpaid medical bills?

The bottom 25% of hospitals reported putting 1.43% or less of expenses toward bad debt. The median hospitals reported bad debt totalling 2.45% of their expenses. The top 25% of hospitals spent 3.89% or more of expenses on bad debt.

How does a hospital payment plan work?

A Payment Plan The payment plan will allow you to break the bill into multiple payments over a set amount of time, until the bill is fully paid. Make sure to ask for a payment plan that you can actually afford. Otherwise, the provider may offer a plan that could still be a financial burden for you.

What does Mercy financial assistance cover?

This program provides financial assistance to help qualified patients pay for healthcare based on their financial need. This includes emergency, urgent, or medically necessary care.

What does the assistance fund cover?

The Assistance Fund (TAF) is an independent charitable patient assistance organization that helps patients and families facing high medical out-of-pocket costs by providing financial assistance for their copayments, coinsurance, deductibles, and other health-related expenses.

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What is the phone number for Lima Memorial financial Assistance?

Call Lima Memorial Patient Accounts Department at 567-242-0460.

Who qualifies for financial assistance for medical bills in Ohio?

Patients must have a family income at or below 400% of the federal poverty guidelines or demonstrate docHub financial hardship that prevents them from paying for care. You can find them through HealthCare.gov. You need to provide your name, address, phone number and account number (if available).

What does hospital financial assistance cover?

Most hospitals offer discounts or bill forgiveness based on income. This is called hospital financial assistance, or sometimes charity care. A hospital bill for $15,000 could become $150 or even $0. Dollar For can help you apply for free.

HOSPITAL FINANCIAL ASSISTANCE PROGRAM - Lima Memorial 2026

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