How to apply for Hospital Financial Assistance (Mena Regional Health System) — Polk in Arkansas

Who it's for

Mena Regional Health System, the city-owned hospital in Mena, offers financial assistance (charity care) for medically necessary services to patients who are uninsured or underinsured and cannot pay. Under its policy, patients with family income at or below 200% of the Federal Poverty Income Guidelines may have part or all of their bill written off, depending on savings and other assets, and those between 200% and 300% may qualify for reduced payments. You must apply for Medicaid first if you might qualify. Approval lasts 6 months. Uninsured patients can get up to a 40% discount when they pay in full. For help with the application, call the Patient Financial Counselor at 479-243-2333, Monday through Friday, 8 a.m. to 4:30 p.m.

What you'll need

• Federal or state tax returns for the most recent tax year
• Most recent Social Security income statement, if any
• Pay stubs for 3 months for all employed household members
• Proof of any other income
• Bank statements for 3 months
• Medicaid denial letter, if any

Where to apply

What to say when you call

"Hello, I'm calling to ask about Hospital Financial Assistance (Mena Regional Health System) — Polk. 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 federal or state tax returns for the most recent tax year, most recent Social Security income statement, if any, pay stubs for 3 months for all employed household members — 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

every 6 months (reapply per policy)