PLAIN LANGUAGE SUMMARY OF
FINANCIAL ASSISTANCE AND CHARITY CARE POLICY

Overview: The Lakeland Community Hospital, Inc. Financial Assistance and Charity Care Policy exists to provide eligible patients who may need financial assistance partially or fully discounted emergency or medically necessary hospital care. Patients must apply for financial assistance.

Availability of Financial Assistance: A patient who is uninsured or underinsured, has recently qualified for financial assistance, or is determined eligible under the guidelines of the Policy may be able to receive financial assistance for emergency or medically necessary hospital care. Some services and providers in the Hospital are excluded from the Policy and financial assistance is not available for such services or providers.

Eligibility Requirements: Financial assistance is generally determined by a sliding scale of total household Family Income (as defined in the Policy) based on the Federal Poverty Guidelines. Some patients may be presumptively eligible based on their previous qualification or their eligibility for Medicaid or other federal or state indigent care programs.

Patients with Family Income between 0-200% of the Federal Poverty Guidelines may receive a 100% discount for emergency and medically necessary services. Patients with Family Income between 201-250% of the Federal Poverty Guidelines may receive a 60% discount for emergency and medically necessary services. Patients with Family Income between 251-300% of the Federal Poverty Guidelines may receive a 40% discount for emergency and medically necessary services. Eligible patients will not be charged more for emergency and medically necessary services than Amounts Generally Billed to those patients who have insurance.

How to Apply: Patients seeking financial assistance are required to complete a Lakeland Community Hospital, Inc. Financial Aid Application. Patients may find an application at the link below, the Lakeland Community Hospital registration office located at 42024 Alabama 195, Haleyville, AL 35565, or by calling (205) 485-7151. Patients must cooperate in providing requested information and must return the completed application to the Financial Aid specialist at the address stated above. As Family Income and other relevant factors change, an applicant is required to update his or her application.

Download here and complete the application within 10 days of your discharge.

Download here our complete Financial Assistance and Charity Care Policy.

Please return the completed application and the necessary documents to:

Lakeland Community Hospital
Business Office
Attn: Admitting Director
P.O. Box 780
Haleyville, AL 35565
(205) 486-5213

Monday - Friday
8 a.m. - 5:00 p.m.