Application Guidelines

Upon receiving notice of payment due or in anticipation of receipt of a notice of payment due, a patient, patient guarantor, or legal authorized agent may make application for Financial Assistance.

Patient shall apply for financial assistance consideration by completing the Application for Financial Assistance within 270 days after service is provided. Accounts greater than 270 days old will not be considered for the Financial Assistance adjustment unless the patient, patient guarantor or legal guardian can provide documentation of a major change in their financial situation.

You may obtain an application for Financial Assistance from the Financial Counselor located on the ground floor near the hospital’s main entrance or through our website. Upon completion, the application and all required supporting documents should be returned to the Financial Counselor who will review the documents for completeness. Based upon this review you may be asked to provide additional documentation supporting expenses and/or income.

All applications and supporting documentation will be forwarded to Hillsdale Hospital’s Chief Financial Officer for review and final determination of eligibility. Patients will be notified in writing of their eligibility. Accounts determined to qualify for financial assistance shall be adjusted according to the income table listed below. Accounts determined not to qualify for financial assistance will process through Hillsdale Hospital’s normal billing process.


  • Elective procedures do not qualify for Financial Assistance adjustment.
  • Patients with health insurance must exhaust all available insurance resources before consideration for financial assistance will be given. Patients with no insurance coverage or benefits for services may be eligible for financial assistance.
  • As of the date of services, a single person may not have liquid assets (cash, savings and checking accounts, CDs, stocks and bonds, etc.) of more than $7,500.  A family is not allowed more than $15,000.  If the available balances exceed this amount, patient or guarantor may “spend down” the assets by paying toward medical expenses until the limit is reached.
  • Only accounts in good standing will be eligible for Financial Care adjustment.
  • Patients with no available income with which to make a payment and little or no prospects for finding future earnings may be considered for financial care.
  • A Medicaid denial letter must accompany the Financial Assistance application for consideration.
  • Financial Assistance Adjustments are determined based upon established Federal Poverty Levels.

Hillsdale Hospital Financial Assistance Policy

Additional Resources

Financial Assistance Program—Plain Language Summary
Help understanding healthcare pricing, insurance, payments, etc.