HUNTSVILLE MEMORIAL HOSPITAL

"“Financially Indigent” means a patient whose yearly household income (as defined below) is less than or equal to 200% of the Federal Poverty Guidelines (“FPG”). These financially indigent patients are eligible for a 100% discount on outstanding patient account balances as outlined in Part 1 of the Financial Assistance Eligibility Discount Guidelines (Attachment A)."

documented · checked 2026-10-13 · Financial Assistance Policy – English

"This includes patients who don’t have health insurance and can’t pay their bill as well as patients who have coverage with an insurance carrier but are unable to pay their portion of the bill after insurance pays."

documented · checked 2026-10-13 · Financial Assistance - Huntsville Memorial Hospital

"Citizenship: 1. Must be a US Citizen, verified by valid Certificate of Naturalization or “sponsored alien”. Identity: Two Types of Identification 1. Driver’s license or other form of picture identification. 2. One other form of identification – (Social Security card, Employee ID, voter’s registration card, birth certificate, or marriage license). Income: All applicable items must be presented for proof of household income 1. Proof of employment – Paycheck stubs or letter from employer or previous employer with employer’s name, address, telephone number, length of service and money earned. 2. Social security award letter or copy of current check. 3. Copy of current check from any other source such as retirement, disability, or VA benefits, unemployment, child support, or housing. 4. Food stamp printout / letter or reason for denial. 5. Previous year’s income tax return, W-2 forms, or 1099. 6. Medicare, Medicaid, or CHIP card for any household members. Residency: Two items must be presented for proof of residence 1. Current telephone bill with your address. 2. Current utility bill with physical address of your residence. 3. Voter’s registration card. 4. Property tax statement for residence. 5. Rent receipt or rental/lease agreement."

documented · checked 2026-10-13 · HMH Charity - Combined Documents (00107744).DOC

"Applications can be submitted by: 1. Mail to: Huntsville Memorial Hospital Attn: Financial Counseling Department 125-B Medical Park Lane Huntsville, TX 77340 2. Fax to: 936-291-4271 3. Bring completed application in to office, 125 B Medical Park Lane."

documented · checked 2026-10-13 · HMH Charity - Combined Documents (00107744).DOC

"If you are approved for Financial Assistance, you will be notified by mail, no later than 14 days after the date your fully completed application and all required documents are submitted."

documented · checked 2026-10-13 · Financial Assistance - Huntsville Memorial Hospital

"Please contact us at 936-293-4464 if you need help with your application."

documented · checked 2026-10-13 · HMH Charity - Combined Documents (00107744).DOC

"Financial Counseling hours: Monday - Friday 8a.m. to 5p.m"

documented · checked 2026-10-13 · HMH Charity - Combined Documents (00107744).DOC

"Translations of the Financial Assistance Policy for Charity Care, Application, information regarding amounts generally billed (AGB) and the Plain Language Summary are available in Spanish."

documented · checked 2026-10-13 · HMH Charity - Combined Documents (00107744).DOC