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Financial Assistance

 

Financial Assistance Program Summary

Financial Assistance Policy

Financial Assistance Application

 

Questions?

If you have questions or need assistance completing the application, please contact Krista Cook 406-759-5181, ext.

5959.

When paying your medical bill is a concern

Liberty Medical Center has an extensive financial assistance policy. You may view a copy of the program summary

(link). You may also view a copy of the complete financial assistance policy (link).

 

What is financial assistance?

Liberty Medical Center offers Financial Assistance for emergency and other medically necessary services provided and billed

through Liberty Medical Center. This assistance, ranging from a reduction in the amount of the balance

outstanding up to complete forgiveness of the balance outstanding, is provided to patients demonstrating financial

need and meet the eligibility criteria of the policy.

 

How do I request financial assistance?

You have several options to obtain a Financial Assistance application.

1. Complete Liberty Medical Center’s Financial Assistance Application LINK

2. Contact phone number listed on your billing statement.

3. Visit the registration representative at the clinic or hospital and they will be able to provide you with

an application.

 

What do I need to supply along with my request for financial assistance?

Return the application completed in its entirety along with:

1. Copy of your most recent complete tax return, including all schedules.

2. Copies of the two most recent pay stubs for each wage earner in the household.

3. Proof of third party coverage status or eligibility (including Medicare or Medicaid.)

 

What should I expect?

Your application will be reviewed and a decision will be communicated to you within 30 days. All information is

confidential. To qualify for financial assistance, your household income must be at or below 200 percent of the

federal poverty level. This eligibility is determined by:

1. Family Size

2. Income Guidelines

3. Expenses

4. Terminal Illness

5. Employment Status

6. Third Party Coverage status or Eligibility