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

Who it's for

Sevier County Medical Center in De Queen, a county-owned Critical Access Hospital, provides emergency care and medically necessary services regardless of ability to pay. Its financial assistance program lowers the bill on a sliding fee scale based on income and family size. People whose individual or family income is not more than 225% of the Federal Poverty Guideline may be eligible, and the bill may be discounted up to 100%. Uninsured patients get an automatic 40% discount. Bills from outside providers, such as emergency room doctors and some clinic doctors, are not covered. Approval lasts one year, and you must reapply each year. For help applying, call the Financial Counselor at 870-584-1658.

What you'll need

• Completed financial assistance application
• Last three pay stubs for each employed person in the household
• Last 3 months' bank statements (printed statements only)
• Most recent tax return (Form 1040) for all adults in the household
• If a household member has no income: two letters from a relative, friend or neighbor not living in the household explaining how basic needs are met
• Proof of Medicaid determination, if you applied for Medicaid

Where to apply

What to say when you call

"Hello, I'm calling to ask about Hospital Financial Assistance (Sevier County Medical Center) — Sevier. 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, last three pay stubs for each employed person in the household, last 3 months' bank statements (printed statements only) — 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