Financial Assistance Program
The mission of Granville Health System is to provide the community we serve with the very best health care delivered with compassion and pride. In doing so, we also recognize that medical care is sometimes necessary for patients who are unable to pay for these services.
Therefore a Financial Assistance Program has been established to assist qualifying patients in handling expenses for unexpected medically necessary services. Based on information received you may qualify for financial assistance.
If You Are Working please provide:
Three of your most current pay stubs
If you are married, (3) stubs from your spouse also
Copy of last completed income tax return
If you receive social security income provide proof from one of the following sources:
Recent social security benefit statement
Copy of your bank statement if your check is direct deposit
Copy of your Social Security Check prior to cashing.
If You Are Not Working:
Provide a copy of your wage record
If You Are Not Working And You Are Currently Living With Family Or Friends:
Please have the head of household write a letter to confirm your current situation.
View a copy of the Self Pay Policy (PDF)
Patients will be expected to comply and cooperate in all processes to apply for third party payer programs. Our Financial Assistance Counselors are available to assist you with these processes.
Family Gross Income – Annual gross income must be within 100% -300% of the current Federal Poverty Guidelines
Resource limit not to exceed $3,000
Owned property will be limited to the home in which the guarantor resides as their main residence which includes any land adjacent to the main residence
Automobile(s) needed for transportation to work
Catastrophic Medical Expenses – If you have self pay expenses due to non-routine (catastrophic) medical expenses we will also take these expenses into consideration.
A credit report will be reviewed for current credit extensions.
Balances on accounts which do not qualify for 100% of the Financial Assistance Program may be paid in full. However in the event that payment in full is not possible a scheduled payment plan will be established.
The Patient Financial Services Department is always here to assist you and answer any questions you may have. Please feel free to contact us and help us help you!