How to apply for Hospital Charity Care (Cordell Memorial Hospital) — Washita

Who it's for

Cordell Memorial Hospital provides charity care to people who are uninsured, underinsured, ineligible for a government program, or otherwise unable to pay for medically necessary care. To be eligible, family income may not exceed 200% of the Federal Poverty Guidelines. On the sliding scale, people at or below 150% pay $0, people at 175% pay 50%, and people at 200% pay 80%. Ask a Business Office Representative for a Financial Assistance Application; you have 6 months from the date of service to ask, and the completed application must be returned within 10 working days. Attach proof of income (tax return or the last 2 months of pay stubs), the last 2 months of bank statements, and a denial from Medicaid. The form must be renewed every 6 months. Call 580-832-3339.

What you'll need

• Financial Assistance Application
• Proof of income: tax return or last 2 months of pay stubs
• Last 2 months of bank statements
• Denial from Medicaid

Where to apply

What to say when you call

"Hello, I'm calling to ask about Hospital Charity Care (Cordell Memorial Hospital) — Washita. 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 financial Assistance Application, proof of income: tax return or last 2 months of pay stubs, last 2 months of bank statements — 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