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Financial Assistance and Charity Guidelines

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the assistance form

Since 1920, BAPTIST HEALTH has provided patient-centered services with Christian compassion and personal concern. Consistent with our mission, BAPTIST HEALTH offers financial assistance and charity to eligible patients.

Patients without insurance who do not qualify for any third party or governmental health benefits will receive a discount of 20% of their billed charges.

Additional charity discounts up to 100% may be provided based on completion and evaluation of the Application for Assistance. Please note the Application for Assistance is for hospital charges only, it will not apply to physicians, Radiology Consultants, Pathology Labs of Arkansas, or any other outside services.

Review and approval of additional charity discounts is based on a number of documented criteria including Federal Poverty Guidelines, consideration of income documented by current tax returns or other proof of income, assets, physical abilities to hold gainful employment that is physician documented and the amount of your medical expenses.

Upon completion of the Application for Assistance BAPTIST HEALTH will notify you if you qualify for charity or financial assistance. However, if a completed application is not received within seven days of your hospital discharge, you will begin to receive patient statements for the balance due after your hospital visit.

To be eligible for assistance, the following steps must be completed:

  1. Answer all questions completely.
  2. Sign and date the Application for Assistance.
  3. Attach the required copy of your most recent complete tax return or other proof of income.
  4. Return the Application for Assistance with current tax returns in the self addressed envelope.

PLEASE RETURN THE APPLICATION INFORMATION
PROMPTLY TO AVOID ADDITIONAL STATEMENTS FOR THE
REMAINING BALANCE DUE.

If you have questions, please call Patient Accounts at (501) 202-3900.

For Direct Physician Referral & Appointments: 501-227-8478 or 1-888-BAPTIST(227-8478)

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