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Financial Assistance

Western Wisconsin Health’s financial assistance program provides health care to our patients regardless of their ability to pay. Through our Community Care Program, patients who do not have financial resources to pay for services or have incurred financial hardship may have their medical bill partially or completely forgiven if they meet the requirements.

What is Community Care?

Community Care is a medical center program to provide partial or full financial assistance for services provided at Western Wisconsin Health

Who is eligible for Community Care?

Patients may be eligible for Community Care if they:

  • Have no health insurance;
  • Are not eligible for any private or governmental sponsored coverage (Medicare; Medical Assistance, Medicaid, Badger Care, etc.);
  • Have health insurance coverage, but are responsible for deductibles, coinsurance and other medically necessary services;
  • Have verifiable income that is at or below 300% of the current Federal Poverty Guidelines; and
  • Meet certain income eligibility criteria.

What guidelines are used to determine household income?

Household income is based upon current Federal Poverty Levels as published in the Federal Register.

Program Criteria

  1. A complete and signed Community Care Application that includes confirmation of income and assets. This includes but is not limited to the following:
  • Most recent Federal Tax Return.
  • If no tax return, then:
  1. Pay check stubs with year-to-date earning (3 most recent);
  2. Bank Statements (3 most recent);
  3. Statement of income from any private or government agency that provides you benefits: (pension, grants, scholarships, workers compensation);
  4. Proof of year-to-date child support or alimony payments;
  5. Annual statement of Social Security benefits, or bank statements that show the direct deposit;
  6. Correspondence from governmental agency approving or denying financial assistance;
  7. Documentation substantiating that the patient has applied for Medical Assistance within three months of the application date;
  8. If disabled or unable to work, documentation that the patient has applied for disability coverage and has received a coverage determination;
  9. Assist the Medical Center in determining that all other reasonable payment sources have been exhausted; and
  10. If the patient is deceased, third party documentation that there is no estate to file a claim.

Community Care Guidelines

UN-INSURED: UNDER-INSURED:
Income Level Discount Percentage Income Level Discount Percentage
0 – 100% of FPG 100% 0 – 100% of FPG 100%
101 – 125% of FPG 50% 101 – 150% of FPG 20%
126 – 150% of FPG 20% 151 – 300% of FPG 10%
151 – 300% of FPG 10%

Definition:

Uninsured – A patient is considered to be uninsured when there is no third-party insurance or government program available to provide coverage for the care that is rendered.

Underinsured – A patient may be classified as underinsured when there is an established third-party insurance or government program providing initial payment for services rendered but the resulting balance assigned as the patient’s responsibility to pay is higher than the individual’s personal financial resources can reasonably be expected to cover.

What services are covered by Western Wisconsin Health’s Community Care Program?

All services are eligible for a Community Care Program discount with the following exceptions:

1. Cosmetic services.

2. Accounts placed with Collection Agencies or in a Legal Status.

3. Elective Procedures require independent approval 0-120 days after CCAP approved.

4. Services offered on a Cash Only Basis.

5. Accounts involved in Third Party Litigation.

6. Service Area Eligibility:

  1. Inside Primary Service Area: All Essential Services including Emergent & Elective.
  2. Outside Primary Service Area: Emergent Services only.

How do I apply for Community Care?

You will be required to complete a Community Care Application and provide copies of requested items. All information must be returned within fourteen days of receipt.

Notification of Community Care Decision

You will be notified by mail if you are eligible for Community Care within thirty days of returning all the required information.

If you qualify for Community Care

You will be notified by mail of the amount of Community Care granted. If you are eligible for partial Community Care, you will be responsible for the remaining balance.

If you do not qualify for Community Care

You will be notified by mail of the denial. If you wish to appeal, please write a letter addressed to the Business Services Manager. In the letter, please describe the extenuating circumstance and provide third-party documentation to support your appeal.

Community Care Application

Spanish Community Care Application

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