PLAIN LANGUAGE SUMMARY OF FINANCIAL ASSISTANCE POLICY
You may be eligible for financial assistance if it would be a financial hardship to pay in full the expected out-of-pocket expenses for services at Community Mental Health Center, Inc.
Financial assistance is generally determined by a sliding scale of total household income based on the Federal Poverty Level. No person eligible for financial assistance under the Financial Assistance Policy will be charged more for emergency or other medically necessary care than amounts generally billed to individuals who have insurance covering such care.
To apply for financial assistance, you may:
- Review information located below the Plain Language Summary, then complete the Request for Financial Assistance Policy (FAP) Form located in the section below titled “Applying for Financial Assistance”;
- Request information by mail at the following address: Community Mental Health Center, Inc., ATTN: Patient Accounts, 285 Bielby Road, Lawrenceburg, IN 47025, or
- Request information by phone by dialing CMHC, Inc. at (812) 537-1302.
The Financial Assistance Policy (FAP) Application Form and the Plain Language Summary can be offered in a variety of languages. CMHC, Inc. provides assistance through the use of a qualified translation service. For information about CMHC’s Financial Assistance Policy and translation services, call (812) 537-1302.
The application process involves filling out the Financial Assistance Policy (FAP) Application Form and submitting the form, along with supporting documents, to CMHC for processing. You may inquire about applying in person by phoning (812) 537-1302. Financial assistance applications are to be submitted to the following address: Community Mental Health Center, Inc., ATTN: Patient Accounts, 285 Bielby Road, Lawrenceburg, IN 47025.
CMHC, INC. FINANCIAL ASSISTANCE POLICY
CMHC, Inc. offers financial assistance for care provided to eligible individuals and families. As a nonprofit health care organization, CMHC cares about the patients and communities we serve through better health and better health care.
Our staff can help you:
- Apply for health insurance through Marketplace
- Apply for government assistance (Medicaid)
- Determine if you qualify for financial assistance from CMHC
You may be eligible for assistance if you can show you have financial need and provide CMHC staff with necessary information regarding your finances. Discounts will be based on family income and family size only.
Your financial circumstances will not affect your care. All patients are treated with respect and fairness.
Applying for Financial Assistance
You may apply for financial assistance at any time – before, during or after your care – up to 240 days after the first billing statement date.
To participate in the Financial Assistance process:
- fill out the Request for Financial Assistance Policy (FAP) Application form (Click here for the FAP Application Form)
- include the supporting documents listed on the form
- our staff will determine whether you qualify for CMHC financial assistance
- financial assistance approval will be in effect for 12 months from the date of approval, or until your financial circumstances change, whichever comes first.
Income Guidelines for Financial Assistance
The amount of financial assistance you may receive is based upon Federal Poverty Level information established by U.S. government each year. In addition to your income, the discount will also take into account your family size. (Click here for Subsidy Calculator)
Financial assistance is primarily for Indiana residents. Discounts under this policy do not apply to co-insurance, deductibles, and co-payments, except where specifically noted.
In the case of non-payment after 90 days from the date of the billing statement, CMHC, Inc. will forward your financial account information to an independent letter service that will deliver up to seven reminders via mail and phone call regarding your balance. At that time, you can either pay your bill in full or make payment arrangements with our billing department. You can apply for financial assistance at that time as well, if you have not already done so. If no payment is received, or if payment arrangement is not established after completion of the letter service, your account will be forwarded to a collection agency.
FAP Covered Providers
The Financial Assistance Policy covers all CMHC providers delivering emergency or medically necessary care in the hospital facility or in an outpatient office.
You can get more information about our Financial Assistance Policy and an application, or make a request to receive written notice or communication electronically, by calling (812) 537-1302 and asking for the Billing Department.