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Northside financial assistance application 2025

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The document is a cover letter for the Hospital Financial Assistance Application at Northwest Community Hospital (NCH) and Day Surgery Center II (DSV). It outlines various financial assistance programs available to uninsured and insured patients, including self-pay discounts, presumptive eligibility, and catastrophic discounts. The application process is detailed, emphasizing the need for supporting documents and providing contact information for further assistance. The hospital aims to help patients access free or discounted care based on their financial situation.

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Click ‘Get Form’ to open the northside financial assistance application in the editor.
Begin by filling out the 'Applicant Information' section. Provide your name, contact details, and Social Security number if applicable. If the patient is a minor, include parent or guardian information.
In the 'Additional Family Members/Dependents' section, list any dependents that may affect your eligibility for assistance.
Complete the 'Employer Information' section with details about your employment status, including employer name and income.
Detail all sources of income in the 'Other Income Information' section. Be thorough to ensure accurate assessment of your financial situation.
Fill in your monthly mortgage or rent payment under the relevant section. If you have no such payments, provide supporting documentation as needed.
List your assets in the designated area, ensuring you include approximate values and necessary documentation for verification.
Finally, review and sign the application. Ensure all required documents are attached before submission.

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

Do hospitals receive federal financial assistance?

Although health facilities receive federal payments for services provided to individuals enrolled in federal programs, these payments are generally not intended to keep health facilities operational. The challenges that health facilities may face raise questions about potential sources of federal support.

Do hospitals have to treat you if you cant pay?

Because of EMTALA, you cant be denied a medical screening exam or treatment for an emergency medical condition based on: If you have health insurance or not. If you can pay for treatment.

How to request for financial assistance?

5 Tips for Asking for Financial Help Figure out Your Needs. Youll feel more comfortable asking for help when you have a clear picture of your needs. Ease into It. Explain the Stakes. What will happen if you dont get financial help? Have a Plan. Be Gracious.

What falls under federal financial assistance?

Federal financial assistance (FFA) is assistance that grantees receive or administer in the form of grants, cooperative agreements, non-cash contributions or donations of property, direct assistance, loans, loan guarantees, and other types of financial assistance.

What is the phone number for Northside Hospital billing?

Our mailing address has changed; please be sure to update your bank with the new address provided on your billing statement. For assistance, please contact Northside Hospital Customer Service at 404-851-6500 or contact us through PatientWallet at northsidewallet.com via Messages or Chat.

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How do I get financial help in Oklahoma?

Financial Assistance Employment Training. Helping job seekers along their journey. WIC. Nutrition education and supplemental food program. Medicaid. You may be eligible for Medicaid. SNAP. Supplemental Nutrition Assistance Program. TANF. Temporary Assistance for Needy Families. Bethel Foundation.

How to get financial assistance for a hospital bill?

Contact the Hospitals Financial Assistance Office: Many hospitals have financial aid programs that can help reduce your bills based on your income and financial situation. They may offer payment plans or charity care.