{"hospital":{"ccn":"450090","name":"NORTH TEXAS MEDICAL CENTER","city":"GAINESVILLE","state":"TX","zip":"76240","phone":"940-612-8600","ownership":"Voluntary non-profit - Private","website_domain":"ntmconline.net","system":null},"version":1,"status":"published","eligibility":{"free_care_max_fpl":{"value":"200","layer":"documented","quote":"Financially Indigent. \"Financially Indigent\" means an uninsured patient whose Yearly Household Income is less than or equal to 200% of the Federal Poverty Guidelines (\"FPG\").","source_id":"fap-b7aafba37c6fd849","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"discount_tiers":null,"asset_test":null,"residency":null,"insured_patients_covered":null,"min_balance":null,"services_excluded":null},"programs":{"presumptive":{"value":["Medicaid"],"layer":"documented","quote":"Any patient that qualifies for any state or local Medicaid or Indigent Care program is automatically deemed eligible for financial assistance for services provided, including for non-covered services or charges for days exceeding a length of stay limit.","source_id":"fap-b7aafba37c6fd849","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"state_programs":null},"apply":{"form_url":null,"form_version":null,"documents_required":{"value":["proof_of_income","tax_return","bank_statements","social_security_letter"],"layer":"documented","quote":"Household income will be documented through any of the following mechanisms: A. Third Party Documentation. By the provision of third party financial documentation including IRS Form W-2 (Wages and Tax Statement); pay check remittance; individual tax return; telephone verification by employer; bank statements showing income deposits or expenses; Social Security payment remittance; worker's compensation payment remittance; unemployment insurance payment notice; unemployment compensation determination letters; response from a credit inquiry and other publicly available information; or other appropriate indicators of the patient's income.","source_id":"fap-b7aafba37c6fd849","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"documents_reported":null,"submit_methods":{"value":[{"kind":"mail","detail":"by mailing a request to 1900 Hospital Blvd., Gainesville, Texas 76240"},{"kind":"fax","detail":"via fax at (940) 612-8492"},{"kind":"phone","detail":"by calling (940) 612-8389"},{"kind":"in_person","detail":"These documents are also available in the hospital’s admissions area and billing department"}],"layer":"documented","quote":"Free copies of the plain language summary, financial assistance policy and financial assistance application are available as links below. These documents are also available in the hospital’s admissions area and billing department, via fax at (940) 612-8492, by calling (940) 612-8389, or by mailing a request to 1900 Hospital Blvd., Gainesville, Texas 76240.","source_id":"fap-2e48ae44c157e259","checked_on":"2026-10-14","confidence":1.0,"support_count":0},"window_days_from_first_bill":null,"decision_days":null,"decision_days_reported":null},"collections":{"eca_wait_days":null,"collection_agencies":null},"contacts":{"phone":null,"hours":null,"languages":null},"coverage":{"facilities":null,"provider_list_url":null},"sources":[{"id":"fap-2e48ae44c157e259","kind":"hospital_web","url":"https://ntmconline.net/your-hospital/financial-assistance","title":"Financial Assistance | North Texas Medical Center","fetched_on":"2026-10-14","sha256":"2e48ae44c157e2597825772b08179311ced8d663200aad5cea28799a6a25b313","effective_date":null},{"id":"fap-b7aafba37c6fd849","kind":"hospital_web","url":"https://ntmconline.net/wp-content/uploads/2026/08/Financial-Assistance-Policy-English-2.pdf","title":"Financial Assistance Policy English","fetched_on":"2026-10-14","sha256":"b7aafba37c6fd849a9e9382af5b6d0d0061391e82f300afbec3e9572197fba25","effective_date":null},{"id":"fap-71876e7fc331ba7c","kind":"hospital_web","url":"https://ntmconline.net/wp-content/uploads/2026/08/Financial-Assistance-Policy-Spanish.pdf","title":"Financial Assistance Policy Spanish","fetched_on":"2026-10-14","sha256":"71876e7fc331ba7c3ba2e07ff332787786aba882a0c39c5201628bf982768afc","effective_date":null},{"id":"fap-8873ef3de5a68252","kind":"hospital_web","url":"https://ntmconline.net/wp-content/uploads/2025/05/Provider-and-Exclusion-List-.pdf","title":"Provider and Exclusion list for Financial Assistance","fetched_on":"2026-10-14","sha256":"8873ef3de5a68252779a3ae9646541fcf9df9143352afb954a2562a5bed6177a","effective_date":null}],"accuracy":null}