Financial Assistance

Amberwell Hiawatha

Amberwell Hiawatha provides care to patients in our service area without regard to their ability to pay for the services. Realizing that many in our service area need special consideration in this regard, Amberwell Hiawatha provides a significant amount of services at no charge or a reduced cost to eligible persons who are indigent cannot pay for care. Discounts for
qualified patients are based on a percentage of the Federal Poverty Guidelines. These guidelines are updated annually. Patients may apply at the time of service, or up to 240 days after receiving their first statement. Before applying the discount, the total charges will first be reduced by the average percentage of write off for all payer contracts.

Persons and services NOT eligible:

• Non U.S. citizens, lacking immigrant status (including visitors and students).
• Persons who reside outside of Amberwell Hiawatha service area at the time of service based on location.
• Elective/non-emergent procedures including but not limited to: cosmetic type of services, fertility and infertility treatment and procedure including birth control, circumcision, hearing aids and evaluations, weight loss programs unless diabetes related, sports physicals, and Lap Band procedures.
• Persons not cooperating to obtain eligibility or payment assistance from third party resources.
• Collection agency accounts that have incurred legal fees.

Eligibility Guidelines:

Eligibility is based on residency, gross income and household size. The discount is given only after all payment sources have been exhausted. 

1. Residency:

• • • Applicant must be a permanent resident of Amberwell Hiawatha’s service area. A post office box is not acceptable. A utility bill or another form of mail addressed to the applicant at the permanent residence will be required.
      • Primary service area in Kansas: Denton, Everest, Fairview, Hamlin, Hiawatha, Highland, Horton,
        Kickapoo Reservation, Morrill, Padonia, Powhattan, Reserve, Robinson, Severance, White Cloud
        and Willis.
      • Primary service area in Nebraska: Falls City
      • If a person is an immigrant, applicant must have an “Alien Resident Card” or a “United States Citizen Identification Card”, not a temporary card or pending status.

2. Income:

• • • All applicants will be asked to disclose and document all sources of income received by the household.
    • Patient or family must have written verification of household income for three or twelve months 

3. Household:

• • A household is a group of people who live together. They must be connected by marriage, civil partnership, or be a recognized couple (same sex or opposite sex), or they can be related – a child, parent, sister, brother, nephew, niece or in-law for instance – or have another recognized connection such as fostering or adoption. A household is all people living together in one house collectively.

To inquire about financial assistance please call Amberwell Hiawatha Financial Counselor at (785) 742-6372. You may obtain Financial Assistance information and an application at our Financial Counselor, hospital outpatient registration, &
Emergency Department registration areas. You may also find our Financial Assistance application and guidelines online at www.amberwellhealth.org/patient-resources/. Financial Assistance signs are also posted at hospital outpatient & ED registration desks. Financial Assistance notification is also included on patient statements and letters.

• Financial Assistance Application
• Financial Assistance – Plain Language Summary
• Financial Assistance Policy

Financial assistance may be applied on any account(s) that have been assigned to an outside collection agency. Amberwell Hiawatha can place accounts with a collection agency within 120 days, however, the collection agency cannot begin any extraordinary collection actions before the first 240 days from the date of the first statement.

Definition of Household

A household is a group of people who live together. They must be connected by marriage, civil partnership, or be a recognized couple (same sex or opposite sex), or they can be related – a child, parent, sister, brother, nephew, niece or in-law for instance – or have another recognized connection such as fostering or adoption. A household is all people living together in one house collectively. The poverty guidelines are applied to the household as a whole and not the individual.

Definition of Income

Income is the total annual cash receipts before taxes from all sources, for all persons in the family unit, with the exceptions noted. Income data for a part of a year may be annualized in order to determine eligibility – for instance, by multiplying four the amounts of income received during the most recent three months. Income includes money, wages (including overtime), and salaries before any deductions. Income also includes gross receipts from non-far or farm self-employment. Income includes (but not limited to ) regular payment from social security, railroad retirement, unemployment, compensation, strike benefits from union funds, workers’ compensation, veterans’ payments, public assistance.

Supplemental Security Income, General Assistance or General relief money payments, training stipends, alimony, child support and military family allotments or other regular support from an absent family member or someone not living in the household; private pensions, stocks, bonds, government employee pension (including military retirement pay) and regular insurance or annuity payments; college or university scholarships, grants, fellowships, and assistantships; and dividend, interest, net rural income, net royalties, receipts from estates or trusts, inheritance and net gambling or lottery winnings.

Presumptive Eligibility

There are instances when a patient may appear eligible for financial discounts, but there is no financial assistance form on file or a lack of supporting documentation. In the event there is no evidence to support a patient’s eligibility for financial assistance, Amberwell Health may use outside agencies or vendors in determining eligibility and potential discount amounts. These resources may use demographic and household information and/or credit scoring technology to determine the percent of assistance to apply to the patient’s account. Patients who meet presumptive eligibility criteria may be granted financial assistance without completing the application.