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Charity Care/Financial Assistance Application Form Instructions This is an application for financial assistance (also known as charity care) at Lourdes Health. Washington State requires all hospitals
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How to fill out washington state charity care
How to fill out washington state charity care
01
Obtain an application for charity care from the hospital or healthcare facility where you received services.
02
Fill out the application completely and accurately, providing all requested information about your income, assets, and expenses.
03
Gather any required documentation to support your application, such as tax returns, pay stubs, and bank statements.
04
Submit your completed application and supporting documents to the hospital's financial assistance department.
05
Wait for a determination on your charity care application, which can take several weeks. Be sure to follow up with the hospital if you have not received a response.
Who needs washington state charity care?
01
Individuals and families who do not have health insurance or who are underinsured may need Washington state charity care.
02
Those who are unable to pay for necessary medical services and meet the income guidelines set by the hospital or healthcare facility may qualify for charity care.
03
People facing financial hardship or significant medical expenses may also benefit from Washington state charity care.
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What is Washington state charity care?
Washington state charity care is a program that provides free or discounted medical services to low-income individuals who do not have health insurance.
Who is required to file Washington state charity care?
Hospitals and healthcare providers in Washington state are required to file charity care reports.
How to fill out Washington state charity care?
To fill out Washington state charity care, healthcare providers must gather information on income, assets, family size, and medical expenses of the patient.
What is the purpose of Washington state charity care?
The purpose of Washington state charity care is to ensure that low-income individuals have access to necessary medical care without facing financial hardship.
What information must be reported on Washington state charity care?
Information such as patient demographics, income, assets, medical services provided, and discounts offered must be reported on Washington state charity care reports.
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