How to apply for Hospital Financial Assistance (Golden Valley Memorial Healthcare) — Henry in Missouri

Who it's for

Uninsured and underinsured residents of Henry County can apply for financial assistance (charity care) at Golden Valley Memorial Healthcare for emergency and medically necessary care. Discounts are based on household size and income compared with the Federal Poverty Level. 1600 N. Second Street, Clinton, MO. Page states "Financial assistance is determined using current federal poverty guidelines", "Patients with incomes at or below 100% of Federal Poverty Guidelines (FPG) may receive a 100% discount", 101-250% of FPG qualifies for an 80% discount, and uninsured patients get "A 40% discount off full charges for medically necessary services" automatically. Applications must be turned in to Patient Accounts within 240 days of receiving a bill. Page contact numbers: Scheduling 660.890.7300, Switchboard 660.885.5511. verbatim_caveat: gvmh.org sits behind Cloudflare and 403s plain fetchers - a browser user agent is required.

What you'll need

• Confidential Information Sheet / Application Form
• Current income tax return (Form 1040 and Schedule C, E or F if applicable)
• Payroll check stubs for the past 30 days
• Documentation of other income (Social Security, disability, unemployment)
• Current Medicaid denial letter (for the 100% discount)
• Proof of primary residence (state-issued ID or equivalent)

Where to apply

What to say when you call

"Hello, I'm calling to ask about Hospital Financial Assistance (Golden Valley Memorial Healthcare) — Henry. 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 confidential Information Sheet / Application Form, current income tax return (Form 1040 and Schedule C, E or F if applicable), payroll check stubs for the past 30 days — 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)