Financial Assistance

Memorial Hospital and its affiliated hospital based physicians (including Primary Care, Orthopedics and Women's Health) offer 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.

As part of the financial counseling application process, the hospital will assess your potential eligibility for health insurance coverage through federal or state programs such as New Hampshire Medicaid or the new health insurance marketplace exchange. If it is determined that you may be eligible for one of these programs, the hospital will request that you apply for such coverage.

Amounts Generally Billed Calculation (pdf)

Criteria Categories for Financial Assistance

  1. Family income, in relation to federal poverty guidelines;
  2. Assets (e.g. home, bank account, and stocks);
  3. Any additional financial hardship;
  4. You must be receiving medically necessary care.

Eligible Services

Financial assistance may be used to cover acute, emergency, outpatient and physician charges, as well as amounts due after insurance payments, including deductibles, co-insurance and co-payments.

How To Apply For Financial Assistance

Call our financial counseling services at 603-356-5461, ext. 2220. A financial counselor will advise you and suggest other sources that might provide financial assistance.

When a person wishes to apply for the hospital's Healthcare Assistance Program, a financial application is filled out. No financial application will be refused. Appointments to review applications are required at the discretion of the financial assistance counselor.

Please submit the required documents through postal service mail or in person. Do not email copies as we cannot guarantee the security of your personal information.

All completed applications will be processed in accordance with the existing Health Care Assistance guidelines.

Financial Assistance Office Hours

Mon. - Fri.  – 8:00am to 4:00pm (other times may be available by appointment - call for arrangements)

Memorial Hospital Certified Application Counselors

Working with the Certified Application Counselors, the public can get one-on-one help with understanding how the online process works for the health insurance exchange. Although they cannot actually complete the application for the person or recommend plans, they are able to support individuals as they go through the process. People can call with questions or to set up an appointment with one of the counselors. They are available Monday through Friday, from 9am to noon, and 1 to 3pm. Calls should be directed to 356-5461 ext. 2220.

Appeal Process For Denials

If after review the application for healthcare assistance is denied, you will be notified in writing. The letter will be signed by the Department Director with a phone number and extension for further contact.

You have the right to appeal the decision to deny healthcare assistance. This can be done by phoning the Healthcare Assistance Program representative, writing to the Healthcare Assistance Program, or appearing in person to appeal the decision.

At the time of appeal, the entire process will be reviewed with you or the guarantor and the specific reason for the denial will be discussed and explained. If you or the guarantor have additional information to support a reversal of the denial, you should present it at this time. A decision based on the appeal process will be issued in writing within five business days of the appeal and signed by the manager.

If the appeal is denied, you or the guarantor have five business days from receipt of the decision to contact the department manager to review the appeal denial.

For additional information, contact:
Financial Assistance Office
Phone 603-356-5461, ext. 2705

You can email your questions to us here.