How to apply for Hospital Financial Assistance (Jefferson Regional) — Jefferson in Arkansas

Who it's for

Jefferson Regional in Pine Bluff offers financial assistance to patients who cannot pay all or part of their hospital bill. If your total household income is under the Federal poverty amount, you pay nothing. A sliding scale from 101% up to 300% of the Federal Poverty Guidelines gives a partial discount; a family making three times the poverty level may get a 20% discount. People with insurance may get help with balances left after insurance pays, and uninsured patients who do not qualify by income may still get up to a 20% discount. Proof of income and assets is required. To start, call the Business Office patient representatives at 870-541-7964, Monday through Friday, 8 a.m. to 5 p.m., or pick up an application at 1600 W 40th Street, Pine Bluff.

What you'll need

• Last two pay stubs for each employed member of the household
• Last two years tax returns for self-employed individuals
• Proof of residency such as driver's license, utility bills or lease agreement
• If a household member has no income: two letters from a friend or neighbor explaining how basic financial needs are being met

Where to apply

What to say when you call

"Hello, I'm calling to ask about Hospital Financial Assistance (Jefferson Regional) — Jefferson. 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 last two pay stubs for each employed member of the household, last two years tax returns for self-employed individuals, proof of residency such as driver's license, utility bills or lease agreement — 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 (reapply per policy)