How to apply for Hospital Financial Assistance (Dallas County Medical Center) — Dallas in Arkansas

Who it's for

Dallas County Medical Center in Fordyce has a financial assistance program for uninsured or underinsured patients in its service area who cannot pay for all or part of their care. No one is denied services because they cannot pay, and a discounted sliding fee schedule is available based on family size and income. Approved help is applied to the self-pay part of your bill and is good for one year. Turn in a complete application to the Business Office within 10 working days, with proof of income such as a current W-2, 1099, most recent tax return, check stub, or a bank statement showing direct deposit of SSI or Social Security. If your finances change, such as a job loss or the death of a spouse, you can reapply. Call the hospital at 870-352-6300.

What you'll need

• Completed financial assistance application
• One proof of income: current W-2, 1099, most recent tax return, check stub, or bank statement showing direct deposit of SSI or Social Security

Where to apply

What to say when you call

"Hello, I'm calling to ask about Hospital Financial Assistance (Dallas County Medical Center) — Dallas. I'd like to know whether I may qualify, what documents I need, and whether I can apply online, by mail, by phone, or in person. I understand I may need completed financial assistance application, one proof of income: current W-2, 1099, most recent tax return, check stub, or bank statement showing direct deposit of SSI or Social Security — is anything else required? What is the best next step?"

Tip: have a pen ready, ask for the person's name, and write down any case or reference number they give you.

Renewals

annual