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This document outlines the New Jersey Hospital Care Payment Assistance Program which provides free or reduced charge care for patients who require hospital services and meet specific eligibility criteria.
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How to fill out New Jersey Hospital Care Payment Assistance Fact Sheet

01
Obtain the New Jersey Hospital Care Payment Assistance Fact Sheet from the hospital or their website.
02
Read the instructions on the fact sheet carefully.
03
Fill out your personal information such as name, address, and contact details.
04
Provide information about your income, including any supporting documentation required.
05
List your medical expenses and any other relevant financial information.
06
Review the completed form for accuracy.
07
Submit the form to the designated hospital department, either in person or via mail.

Who needs New Jersey Hospital Care Payment Assistance Fact Sheet?

01
Individuals or families who are uninsured or underinsured.
02
Residents of New Jersey seeking assistance with hospital bills.
03
Patients who have low income and can demonstrate financial need.
04
Anyone who has received care from a New Jersey hospital and is struggling to pay the bills.
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If medical debt goes unpaid for a period of time, a hospital or other health care provider may decide to stop providing you services.
WHAT IS THE HOSPITAL CARE PAYMENT ASSISTANCE PROGRAM? The New Jersey Hospital Care Payment Assistance Program (Charity Care Assistance) is free or reduced charge care which is provided to patients who receive inpatient and outpatient services at acute care hospitals throughout the State of New Jersey.
Each hospital runs its own medical bill forgiveness program. They get to decide how patients must apply and who qualifies. Hospitals typically consider the patient's income, the number of people in the household, and the bill's age when deciding who qualifies.
If you do nothing and don't pay, you could be facing late fees and interest, debt collection, lawsuits, garnishments, and lower credit scores.
Contact the billing department: Be polite but firm in requesting reduced fees or payment plans. Prepare your case: Gather all necessary documentation, including your insurance explanation of benefits (EOB). Appeal to your insurer: If needed, submit a formal request to lower the charges further.
NJ FamilyCare/Medicaid Provides free or low-cost health coverage that may help pay for medical bills, doctor visits and prescriptions for certain low income individuals or families.
Each hospital runs its own medical bill forgiveness program. They get to decide how patients must apply and who qualifies. Hospitals typically consider the patient's income, the number of people in the household, and the bill's age when deciding who qualifies.
Bad debt is the unpaid balance due for services for which hospitals did expect to receive payment. Medicare is the only payer that provides some relief from bad debt incurred by patient non-payment. All other bad debt is unrecoverable and becomes a write-off for IRS purposes.

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The New Jersey Hospital Care Payment Assistance Fact Sheet provides information about the financial assistance programs available for patients who are unable to pay for hospital care.
Patients who seek financial assistance for hospital care in New Jersey and do not have insurance coverage or are under-insured are required to file this fact sheet.
To fill out the fact sheet, patients must provide their personal information, income details, and any supporting documentation regarding their financial situation as specified in the form instructions.
The purpose of the fact sheet is to assist patients in accessing available financial aid programs, ensuring that those in need receive necessary medical care without facing overwhelming financial burdens.
The information that must be reported includes personal identification details, income sources, household size, and any other relevant financial information required to assess eligibility for assistance.
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