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Financial assistance: plain language summary

Great Plains Health's mission is to inspire health and healing by putting patients first -- always. That means providing medically necessary services to all, regardless of a patient's financial situation. As part of our contribution of resources, advocacy and community support to promote the health status of the community, which we serve, we will provide financial assistance to patients with a demonstrated inability to pay for medically necessary services in accordance with the hospital's Financial Assistance Policy.

All patients (including those with insurance) may apply for financial assistance by submitting a completed financial assistance application in accordance with the instructions on the application. Great Plains Health determines the need for financial assistance by evaluating each individual patient's relevant circumstances, such as income, assets or other resources available to the patient or the patient's family and the amount of the outstanding balance. It is ultimately the patient's responsibility to provide the necessary information to qualify for financial assistance. There is no assurance that the patient will qualify for financial assistance.

Established eligibility criteria and discount guidelines will be used to determine what amount, if any, of an outstanding patient account balance qualifies for financial assistance. Patients whose yearly household income is at or below 250 percent of the Federal Poverty Guidelines (FPG) will receive a discount. After receiving proper documentation, patients may qualify for Financial Assistance, if their income falls between the 100 percent and 250 percent Poverty Guidelines for the number in the household. They may receive 25, 50, 75 or 100 percent assistance if all requirements are met in the application process.

No patient who qualifies for financial assistance will be charged more for emergency or other medically necessary care than amounts generally billed to patients having insurance.

Free copies of this Plain Language Summary, the Financial Assistance Policy, and the financial assistance application are available in the hospital's admissions area and emergency department, or by calling 308.568.7112 and can be requested by mail at PO Box 1167, North Platte, NE 69103. Translations will be available upon request.

The hospital's Patient Representatives are available to answer questions and provide information about the Financial Assistance Policy and to assist with the financial assistance application process. The hospital's Patient Representatives may be reached between the hours of 8 a.m. and 4:30 p.m. Monday through Friday by calling 308.568.8600 or in person at 601 W Leota Street, North Platte, NE on the second floor of the GPEast Tower.

The table below is based upon the 2019 Federal Poverty Level (FPL).

Number in
House

2019 FPL

250%

450%

1

$12,140

$30,350

$54,630

2

$16,460

$41,150

$74,070

3

$20,780

$51,950

$93,510

4

$25,100

$62,750

$112,950

5

$29,420

$73,550

$132,390

6

$33,740

$84,350

$151,830

7

$38,060

$95,150

$171,270

8

$42,380

$105,950

$190,710


CALCULATION PROCESS

The matrix below is to be utilized for determining the level of assistance for patients who are uninsured.

  1. Patients who are uninsured and at or below the 250 percent of FPL Guidelines will receive a full write off of charges;
  2. For uninsured patients who exceed the 250 percent of FPL Guidelines, but have income less than the 450% FPL Guidelines, a sliding scale will be used to determine the percent reduction of charges that apply. The matrix for the discount is provided below.
  3. Patients who are insured and at or below the 25% of FPL Guidelines must first satisfy any related copayments, deductible/coinsurance on a sliding scale up to $150 per episode of care prior to being eligible for a full, discounted, or catastrophic write off of charges.

Eligibility criteria

Percentage of Poverty
Guidelines

Discount
percentage

Catastrophic cap

Up to 250%

100%

N/A

251 - 300%

75%

25%

301 - 350%

50%

25%

351 - 400%

25%

25%

401 - 450%

10%

25%

Over 451%

Determined on an
exception basis

Determined on an
exception basis


Have questions or ready to apply?

If you feel you may qualify and are interested in speaking with a patient financial counselor, please call 308.568.7112 or download a Financial Assistance Application, complete the form and return it to Patient Financial Services at Great Plains Health, 601 W. Leota St. North Platte, Neb 69101.


Additional Financial Assistance Documents

Financial Assistant Program Application
Room & Board Statement
Financial Assistance Policy
This policy contains all of the terms and conditions for receiving financial assistance with your hospital bills, download by clicking on your preferred language below.

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