Patient Financial Assistance Plan

Plain Language Summary

Healthcare Assistance Program

Patient Financial Assistance Plan

The Sumner County Hospital District No. 1 Financial Assistance Policy, referred to as Healthcare Assistance, exists to provide eligible patients partially or fully discounted emergent or medically-necessary hospital care. Patients seeking Financial Assistance must apply for the program, which is summarized below.

Eligible ServicesEmergent and/or medically necessary healthcare services provided by Sumner County Hospital District No. 1.

Eligible Patients Patients receiving eligible services, who submit a Healthcare Assistance Application (including related documentation/information), and who are determined eligible for Healthcare Assistance by Sumner County Hospital District No. 1.

How To ApplyHealthcare Assistance Applications may be obtained/completed/submitted as follows:

  • Obtain an application at Sumner County Hospital District No. 1 Admissions or at Patient Financial Services;

  • Request to have an application mailed to you by calling 620-845-6492;

  • Request an application by mail to Sumner County Hospital District No. 1, 601 S Osage, Caldwell, KS, 67022;

  • Download an application through the Sumner County Hospital District No. 1 website at http://www.sumnercountyhospital.org.

Determination of Healthcare Assistance Eligibility - Generally, patients are eligible for financial assistance based on their income level and assets. Patients with family income of 250% of the federal poverty level or less may be eligible for a discount of 100%. Patients with family income of over 250% of the federal poverty level may be eligible for a discount of 40% of Average General Billed amount (AGB). See Schedule A of the Financial Assistance Policy at http://www.sumnercountyhospital.orgfor more information.  Eligible patients will not be charged more for emergency or other medically necessary care than Amounts Generally Billed (AGB) than those patients who have insurance.

This summary, the Healthcare Assistance Policy, and Healthcare Assistance application are available in Spanish at the locations listed above.

Asistencia Financiera para Pacientes