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Financial Assistance at Littleton Regional Hospital
Hospitals in New Hampshire work hard to make quality health care available, affordable, and accessible to all, regardless of ability to pay. Littleton Regional Hospital offers many financial assistance and referral programs to ensure that cost will not be a barrier to anyone in our community getting the health care services they need. If payment of your health care expenses could create a financial hardship for you, our staff will work with you to apply for financial assistance. Information you provide is confidential and is only reviewed by staff processing your application.
Even if you do not feel you qualify for financial assistance, call us anyway to receive an application. There are many factors taken into consideration when determining eligibility. We also may be able to connect you with other resources for which you may qualify.
As part of the financial assistance application process, the hospital will assess your potential eligibility for health insurance coverage through federal or state programs such as New Hampshire Medicaid. If it is determined that you may be eligible for one of these programs, the hospital will assist you in the application process. You will be required to supply the financial or medical documentation that is necessary to secure such insurance coverage.
Criteria Categories for Financial Assistance
- Family income, in relation to federal poverty guidelines
- Assets (e.g. home, bank account, and stocks)
- Any additional financial hardship
- You must be receiving medically necessary care.
Exclusions for Eligibility
Cosmetic procedures and infertility services are not eligible for financial assistance. All other elective or non-emergent services are covered at the discretion of the health provider or hospital.
Financial Assistance Programs available at Littleton Regional Hospital
Littleton Regional Hospital also participates in several statewide programs:
NH Health Access Network
http://www.healthynh.com/fhc/initiatives/access/NHHAN.php
Hospital Access Plus
http://www.nhha.org/nhha/nh_hospitals/
NH Medication Bridge
http://www.healthynh.com/fhc/initiatives/access/medicationbridge.php
How to Apply for Financial Assistance at Littleton Regional Hospital
- Call our Financial Counselor at (603) 444-9560. Our financial counselor will advise you and investigate other sources that might provide financial assistance.
- Complete a financial assistance application: http://www.healthynh.com/fhc/initiatives/access/NHHANapplication_files/NHHAN Application 032505.pdf.
Or you can pick one up at our Financial Counselor’s office or the Patient Financial Services Department at 551 Meadow Street in Littleton., or call us at (603) 444-9560 or (603) 444-9500 to request that one be mailed to you.
Submit the application with the following documents:
- Complete copy of your most recent Federal Income Tax Return and all schedules. Include copies of last year’s W-2 forms.
- Copies of the three most recent, paycheck stubs or a statement from the employer
- Copies of three most recent bank statements (e.g., savings, checking, money market, IRA, 401K, etc.)
- Copies of unemployment, disability compensation benefits statements
- Copies of social security or pension benefits income
- Copy of food stamp allocation
- Copies of government assistance notices, such as Social Security disability and Medicaid
Please submit the above documents through postal service mail or in person; do not email copies, as we cannot guarantee the security of your personal information. Your application will not be considered complete if it is missing any of the required information.
Mail completed applications to:
Littleton Regional Hospital
Financial Counselor
600 St. Johnsbury Rd.
Littleton, NH 03561
Notification
Completed applications will be processed and reviewed by our Charity Care Committee. The Committee meets during the last week of every month. You will be notified by mail of the Committee’s decision within the following 10 days. If you are denied assistance, and disagree with the Committee’s findings, you may call our Financial Counselor to discuss your application, and file an appeal, if you desire.
Please note that financial assistance approval is valid for 6 months, or 12 months if you are a Medicare beneficiary, and a new application will have to be submitted after that time. If approved, you will receive, along with your award decision letter, a card to carry with you showing your level of approval and the effective date. It will also tell you if you are eligible for NHHAN, which is portable and effective at all participating NH Hospitals, or for the Littleton Charity Care program, which is effective only at LRH.
Making payments
We know that health care costs can come up unexpectedly. Whether you are insured or uninsured, whether or not you qualify for financial assistance — we understand that you may have difficulty paying your healthcare costs in full at the time of service or in a lump sum. We are happy to work with all of our patients to set up a payment plan.
Contact
Financial Counselor
(603) 444-9560
Customer Service
(603) 444-9500
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