BLESSING HOSPITAL

"Full Financial Assistance a. Patient has reported income below 275% of the Federal Poverty Income Guidelines at any Blessing location."

documented · checked 2026-10-10 · Financial Assistance

"Presumptive eligibility may be determined on the basis of individual life circumstances that may include, but not limited to: 1. Full Medicaid benefits (non premium or spenddown programs or programs that exceed Blessing full financial assistance income guidelines)"

documented · checked 2026-10-10 · Financial Assistance

"Copy of your most recent filed Federal 1040 Income Tax Return including all schedules, W-2 Statements, and 1099 forms. If you did not file a Return for the most recent filing period, your application must include an explanation of the reason why no Return was filed. • Forms advising status of unemployment, worker's compensation, or Medicaid • Copy of most recent paycheck stubs from all jobs held in the current year showing year to date earnings in the absence of income, a letter of support and/or a declaration of no income from the patient and/or responsible party detailing how the individual's current living needs are being met • Proof of all income such as Social Security, unemployment, disability, pensions, child support, alimony or foster care."

documented · checked 2026-10-10 · Financial Assistance

"To receive the financial assistance form: • Call or write Patient Financial Services. • Visit the billing office at the hospital or clinic. • Download the form at blessinghealth.org."

documented · checked 2026-10-10 · [PDF] ASKING FOR HELP TO PAY A BLESSING HEALTH SYSTEM ...