Financial Assistance

Financial Assistance

PATIENT ASSISTANCE PROGRAM INFORMATION

 Broadwater Health Center is a non-profit hospital offering a broad range of services which are provided with efficiency and sensitivity to the patient’s needs, both medically and financially. It is the policy of Broadwater Health Center to provide medical care to indigent inpatients and outpatients. Your account balance may be adjusted if you qualify. On this page is a financial statement document that we ask you to complete to help us determine your eligibility. Proof of income must be included with the financial statement when it is returned to the Business Office.

 Income will be annualized based upon documentation provided by you and will take into consideration seasonal employment and temporary increases and/or decreases of income .

 If assistance with this financial application is needed please contact your Patient Accounts Representative and they can assist you.

 Your Patient Accounts Representative will notify you by writing of the final determination of eligibility.

 All information relating to the application for Patient Assistance will be kept confidential.

 

Financial Assistance Annual Income Chart

Financial assistance is a discount on your bill based on your income. To apply fill out this packet and return with proof of income.* To check if you may qualify, please refer to the chart below. Find your family size in the left hand column and look across to see where your income falls

 

     

            ANNUAL INCOME

    

FAMILY SIZE

100%

90%

80%

70%

60%

50%

40%

1

$18,210

$19,424

$20,638

$21,852

$23,066

$24,280

$30,350

2

$24,690

$26,336

$27,982

$29,628

$31,274

$32,920

$41,150

3

$31,170

$33,248

$35,326

$37,404

$39,482

$41,560

$51,950

4

$37,650

$40,160

$42,670

$45,180

$47,690

$50,200

$62,750

5

$44,130

$47,072

$50,014

$52,956

$55,898

$58,840

$73,550

6

$50,610

$53,984

$57,385

$60,372

$64,106

$67,840

$84,350

7

$57,090

$60,896

$64,702

$68,508

$72,314

$76,120

$95,150

8

$63,570

$67,808

$72,046

$76,284

$80,522

$84,760

$105,950

 

*PLEASE INCLUDE PROOF OF INCOME WITH Financial Aid APPLICATION

  • Paystubs or proof of other monthly income sources for the last three (3) months. This could include social security income, pension benefits, etc.
  • A complete copy of your most recent tax return(s). The last three months bank statements and savings account statements.
  • Any other information that may be necessary to help you qualify
  • Medicaid denial  letter

Broadwater Health Center Financial Aid Documents

  • The Financial Assistance Policy is a detailed explanation of the BHC Financial Assistance Program
  • The Financial Authorization Form is required to allow authorized BHC personnel to access your financial information
  • The Financial Assistance Application is the main application to apply for financial assistance

Please read the Financial Assistance Policy to gain an understanding of our aid policy. Please download and fill out BOTH the Financial Authorization Form and the Financial Assistance Applicantion. Return both to Broadwater Health Center.

The Financial aid documents are available both as PDF documents.  Just click on the link to view the documents. The PDF documents can be viewed online and printed from your browser.

Financial Assistance Policy:   BHC Financial Aid Policy.pdf

Financial Authorization Form: BHC Financial Authorization Form.pdf

Financial Assistance Application: BHC Financial Assistance Application.pdf

For Further Information contact us at:

110 North Oak Street

Townsend, MT 59644

(406)-266-3186

email: dharrell@bhctownsend.com