How to apply for Hospital Financial Assistance (Great River Health (West Burlington)) — Des Moines in Iowa

Who it's for

Great River Health does not deny anyone services because they cannot pay, and it has a discounted/sliding fee schedule based on family size and income. Insured and uninsured patients getting medically necessary or emergency care may qualify. Patients with no insurance who qualify cannot be charged more than the amount generally billed to people with insurance. Return the completed application to Southeast Iowa Regional Medical Center-West Burlington Patient Billing Department, 1221 S. Gear Ave., West Burlington. For questions, call Patient Financial Services at 319-768-3625, option 2.

What you'll need

• Paycheck stubs from the last two months for everyone in the household over age 18 (except high school students)
• Proof of Social Security income (most recent check, bank statement or benefits letter)
• Most recent state and federal income tax forms
• If unemployed: state unemployment claims and the final paycheck stub from your last job
• A denial letter from the Department of Human Services

Where to apply

What to say when you call

"Hello, I'm calling to ask about Hospital Financial Assistance (Great River Health (West Burlington)) — Des Moines. 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 paycheck stubs from the last two months for everyone in the household over age 18 (except high school students), proof of Social Security income (most recent check, bank statement or benefits letter), most recent state and federal income tax forms — 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)