Patient Financial Services

The James B. Haggin Memorial Hospital will provide medical services without regard to race, color, religion, age, sex, disability, social or economic status.  This notice is to provide information to you on fulfilling your potential financial liability for the medical services provided to you in your time of need.

TO OUR MEDICARE PATIENTS RECEIVING OUTPATIENT SERVICES (including Observation Services):

Routine exams, tests, and self administered medications are non-covered services under your Medicare. These services, if received, will be your responsibility.

We accept assignment on Medicare, Medicaid, Commercial or Group Health Insurance and Liability Coverage (if assignable). You may have an out of pocket expense in the form of a co-pay, deductible, co-insurance, non-covered services and personal items. Some of this may be due at the time of the service. Your registration clerk will inform you of the amount that may be due. We accept payment in the form of cash, check, or credit card (Visa, MasterCard or American Express).

Payment arrangements can be made by contacting the Business Office. Arrangements can be made to pay the balance over an eighteen month period. If your liability is $200 or more we may be able to provide you with some financial assistance.

If your insurance company does not pay your account in 30 days, we may contact you to determine if other efforts can be made or if the account should become your liability. By law, all insurance carriers are supposed to pay claims to providers within 30 days.

PATIENTS WITHOUT INSURANCE:

Financial Assistance Programs are available for patients without insurance. A patient should contact the local Social Services Department to determine eligibility for Medicaid coverage.  As a result of legislation which became effective July 15, 1994, persons who do not qualify for Medicaid Assistance, have no insurance, and their income is at or below the Federal Poverty Guideline, may be eligible for the Kentucky Hospital Care Program (KHCP).  An application can be picked up at registration, in the Business Office or found at our website at www.hagginhosp.org.

The hospital may also be able to provide financial assistance if you do not have insurance and your income falls between the Federal Poverty Guideline and 300% of the Federal Poverty Guideline.  An application can be picked up at registration, in the Business Office or found at our website at www.hagginhosp.org.
Proof of income will be needed in order to make application for this assistance. This may be provided in the form of pay stubs, tax returns, or other documentation of your income.

FEDERAL POVERTY GUIDELINES (Annual Income Limits) Effective 4-01-2012

 

HOUSEHOLD 100% OF THE
POVERTY LEVEL
200% OF THE
POVERTY LEVEL
300% OF THE
POVERTY LEVEL
1 $11,170 $22,340 $33,510
2 $15,130 $30,260 $45,390
3 $19,090 $38,180 $57,270
4 $23,050 $46,100 $69,150
5 $27,010 $54,020 $81,030
6 $30,970 $61,940 $92,910
Each Additional $3,960 $7,920 $11,880

 

DISPROPORTIONATE SHARE PROGRAM (DSH):

If you or someone you know are interested in the Disproportionate Share Program (DSH), please print off and fill out the form below.
Attach the cover letter provided and mail to:

Lilly Frederick
Financial Counselor
James B. Haggin Memorial Hospital

464 Linden Ave.
Harrodsburg, KY 40330

**DISPROPORTIONATE SHARE HOSPITAL PROGRAM COVER LETTER (DSH) pdfIcon
**DISPROPORTIONATE SHARE HOSPITAL PROGRAM APPLICATION (DSH) pdfIcon

For any further questions, please contact the Business Office at:

THE JAMES B. HAGGIN MEMORIAL HOSPITAL
464 LINDEN AVENUE
HARRODSBURG, KY 40330
859-734-5441

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