Financial Assistance

This policy applies to Dartmouth Hitchcock Clinics, Mary Hitchcock Memorial Hospital, Alice Peck Day Memorial Hospital, New London Hospital, and Cheshire Medical Center.

For Mt. Ascutney Hospital and Health Center (MAHHC) in Windsor, Vermont, please refer to the MAHHC Billing and Financial Assistance web page.

All other hospitals in New Hampshire and Vermont are considered non-member facilities.

Please refer to the following sections:

 

Financial assistance policy brochure

Dartmouth Health will provide care for emergency medical conditions and medically necessary services to individuals despite their inability to pay or eligibility for financial or government assistance regardless of age, gender, race, social or immigrant status, sexual orientation or religious affiliation.

Dartmouth Health provides financial assistance to persons who have healthcare needs and are uninsured, underinsured, or ineligible for a government program or are otherwise unable to pay, for medically necessary care or emergency medical conditions based on their individual financial situation.

Dartmouth Health will make reasonable efforts to determine whether a patient is eligible for financial assistance before pursuing collection actions.

For more information, please call 1-844-808-0730 or see our Financial Assistance Policy brochure (PDF).

This summary is available in the following languages:

Back to top

Financial assistance for healthcare services policy

How can you qualify?

The qualifications are:

  • You must be a resident of New Hampshire or Vermont or a non-resident who experiences a medical emergency; and
  • You don’t have insurance or have a high out of pocket responsibility, are not eligible for any government healthcare benefit program, or are unable to pay for your care due to financial hardship; and
  • Your services are medically necessary; or
  • You have a NH Health Access Network Card; or
  • You meet established charity criteria

For full details, see our Financial Assistance for Healthcare Services Policy (PDF).

This summary is available in the following languages:

Back to top

 

Financial assistance application

How do you apply?

First, you will work with our financial counselor to be sure there are no other payment options.

Then you will complete a financial assistance application with required documentation.

For Dartmouth Health patients: Financial Assistance Application (PDF)

This summary is available in the following languages:

Note:

  • You can apply at any point during your care at Dartmouth Health
  • Dartmouth Health will accept your NH Health Access Network Card

Frequently asked questions

  • How is your financial assistance determined?
    You may qualify for a partial or full reduction of your balance based on your income and assets in comparison to the Federal Poverty Levels (FPL) or the impact of the circumstances.
  • When will you know if you are approved?
    You will receive a letter in 30 to 45 days after your application is completed.
  • What happens if you are denied or not approved for 100%?
    If you don't agree with why you were denied or received partial approval for financial assistance, you may send a letter within 30 days of the denial that states why you don't agree. If your application is denied or approved for anything less than 100%, instructions and the mailing address will be sent to you.

If you have other questions, call us at 1-844-808-0730.

Back to top

 

Uninsured discount

Patients without insurance cannot be charged any more than amounts generally billed to people who have insurance covering the same care. Dartmouth Health applies a discount against gross charges to all balances where there is no insurance, resulting in a balance which the patient is expected to pay. The discount is based on the "prospective Medicare" method as described under applicable regulations implementing Section 501(r) of the Internal Revenue Code. This discount is applied prior to billing the patient and prior to applying any financial assistance adjustments. This discount doesn’t apply to any copayments, co-insurance, deductible amounts, pre-payment or package services which already reflect any required discount, or to services classified as non-covered by all insurance companies.

To view the full details regarding the Uninsured discount policy, see the attach the English version of Dartmouth Health Uninsured Discount Policy (PDF).

This summary is available in the following languages:

Back to top

 

Credit and collection policy

To view the full details regarding payment expectations, see the Dartmouth Health Credit and Collection Policy (PDF).

This summary is available in the following languages:

Back to top

 

Budget payment policy

To view the full details regarding payment expectations, see the Dartmouth Health Budget Payment Policy (PDF).

This summary is available in the following languages:

Back to top