How to apply for Hospital Charity Care (Choctaw Memorial Hospital) — Choctaw

Who it's for

Choctaw Memorial Hospital in Hugo has a Charity Care Program for patients who cannot afford to pay for medically necessary care. Eligibility is based on family income and the number of people in the family, and may also be based on whether medical bills would be a medical hardship. Fill out the Charity Care application and send it with photo ID, two proofs of Choctaw County residency for the past year, household income for the last 90 days (such as last year's federal tax return, pay stubs, Social Security or SSI award letter, or pension statements), three months of bank statements, and copies of insurance cards including Medicare or Medicaid. The hospital will tell you within 30 business days if you are approved. If you are denied, you can appeal, re-apply if your situation changes, or set up a payment plan. For help with the form, call the Collections Specialist at 580-317-9500.

What you'll need

• Completed Charity Care Application Form
• State or federal photo ID
• Two proofs of Choctaw County residency for the previous year (such as a utility bill or lease)
• Proof of all household income for the last 90 days (federal tax return, pay stubs, SSA/SSI award letter, pension statements)
• Bank or credit union statements from the last 3 months
• Copies of all current insurance cards, including Medicare and Medicaid

Where to apply

What to say when you call

"Hello, I'm calling to ask about Hospital Charity Care (Choctaw Memorial Hospital) — Choctaw. 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 Charity Care Application Form, state or federal photo ID, two proofs of Choctaw County residency for the previous year (such as a utility bill or lease) — 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)