INDEPENDENCE HEALTH SYSTEM CLARION HOSPITAL

"Patients will receive charity care in a range of 100% with income less than 250% of the Federal Poverty Guidelines, or 75% with income greater than 250% but less than 350% of the Federal Poverty Guidelines (see Appendix A for grid)."

documented · checked 2026-10-13 · [PDF] Independence Health System (IHS) Financial Assistance Policy

"Patients will receive charity care in a range of 100% with income less than 250% of the Federal Poverty Guidelines, or 75% with income greater than 250% but less than 350% of the Federal Poverty Guidelines (see Appendix A for grid)."

documented · checked 2026-10-13 · [PDF] Independence Health System (IHS) Financial Assistance Policy

"Assets – includes any checking and savings accounts, certificates of deposit, and any other non-retirement liquid assets"

documented · checked 2026-10-13 · [PDF] Independence Health System (IHS) Financial Assistance Policy

"Presumptive Eligibility for Charity Care will be considered at 100% in instances when a patient may appear eligible for charity care discounts, but there is no financial assistance form on file due to lack of supporting documentation. In the event there is no evidence to support a patient’s eligibility for charity care, Independence Health System will use one or more of the following criteria to make a determination: patients who qualify for section 8 housing, patient is deceased and no estate, Food Stamp eligibility, patient is homeless or received care from a homeless clinic, and family or friends of a patient that provide information establishing the patient’s inability to pay."

documented · checked 2026-10-13 · Charity Care / Financial Assistance

"The following documents are required to verify income and assets: a. Most recently filed 1040 Tax return b. Social Security Benefits for the current year c. Unemployment Benefits d. Child Support Payments e. Paystub(s) last 30 days f. Pension (copy of bank statement if directly deposited)"

documented · checked 2026-10-13 · [PDF] Independence Health System (IHS) Financial Assistance Policy

"The method(s) for applying or inquiring about our Financial Assistance Policy for Independence Health System: a. To request an application: i. For Butler Memorial Hospital, Clarion Hospital, or Butler Medical Providers, email BHSFinancialClearance@independence.health ii. For Excela facilities, email excelahealth@optum360.com b. Visit our website at www.independence.health where the application is listed under "Patients & Visitors” – “Charity Care/Financial Assistance” or c. The application is listed on the reverse side of your patient statement or d. Contact our office: i. For Butler Memorial Hospital, Clarion Hospital, or Butler Medical Providers, call 724-431-2947 Monday through Friday 8:00am to 4:00pm ii. For Excela facilities, call 866-322-0961, option 4 to speak with a Financial Assistance specialist"

documented · checked 2026-10-13 · [PDF] Independence Health System (IHS) Financial Assistance Policy

"Patients who have applied for Financial Assistance will be notified by telephone or in writing within (30) days of their application as to whether they have been approved or denied."

documented · checked 2026-10-13 · [PDF] Independence Health System (IHS) Financial Assistance Policy

"Collection Agency Referral - IHS may use the services of an external collection agency for the collection of patient debt for nonpayment. This will typically occur 120 days after the initial billing."

documented · checked 2026-10-13 · [PDF] Independence Health System (IHS) Financial Assistance Policy

"For Butler Memorial Hospital, Clarion Hospital, or Butler Medical Providers, call 724-431-2947 Monday through Friday 8:00am to 4:00pm"

documented · checked 2026-10-13 · [PDF] Independence Health System (IHS) Financial Assistance Policy

"For Butler Memorial Hospital, Clarion Hospital, or Butler Medical Providers, call 724-431-2947 Monday through Friday 8:00am to 4:00pm"

documented · checked 2026-10-13 · [PDF] Independence Health System (IHS) Financial Assistance Policy