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Community Care Program


What is the Community Care Program?

Holy Family Memorial developed the Community Care Program to assist their patients with their Holy Family Memorial Network balances based on eligibility and ability to pay.

The Community Care Program has potentially two purposes.

  1. Reduction of your monthly payment- we are aware that people often have many other financial obligations, we can determine from the Community Care application if you would qualify for a reduced payment plan.
  2. Partial or total discount – both partial and total discounts of the charges for services may be available and will be determined based upon the Federal Income Poverty Guidelines, monthly expenses and assets.

Community Care is not an insurance plan. It was designed to provide short-term assistance to those in need. Confidentiality of information and individual dignity will be maintained for all who seek Community Care services with Holy Family Memorial Network.

Eligibility

  • Holy Family Memorial patients with existing balances are eligible to apply.
  • Eligibility is determined based on household income as compared to the Federal Poverty Guidelines.
  • Eligibility is also based on a patient’s medical debt and ability to pay.

What is Not Eligible?

  • Routine care and non-medically necessary services.
  • Pharmacy drugs/supplies, durable medical equipment, and retail store items.
  • Medical Assistance co-payments and spend-downs.
  • Balances already placed with a professional collection agency.
  • Balances payable by other third party payers. (Examples: Federal, State, County programs, Worker's Compensation, Liability Insurance, etc.)
  • Previous personal payments will not be refunded. Discounts if any are only applied once to unpaid balances. If a service has already received a Community Care discount, it will not receive additional Community Care discounting.
  • Bills for medical services provided by Non-Holy Family Memorial Network Providers.

Proof of Income

Please provide copies of the following items: Most recent federal/state tax forms, including all schedules

  • W-2 withholding statements if client didn’t file taxes
  • Paycheck/Unemployment check stubs (past 3 months) or written statement of earnings from your employer (past 3 months)
  • Statement of monthly benefits from Social Security
  • Forms approving or denying unemployment, worker’s compensation or financial aid programs
  • If unemployed, Manitowoc Job Center proof of visit for 4 weeks (Job Service print out)
  • If uninsured but work and have dependent children, must apply for Badger Care and provide proof

Community Care Income Guidelines - View Community Care Income Guidelines 2014

How Do I Apply?

To request a Community Care Application or if you have questions regarding this program you can email us at: pbs@hfmhealth.org or contact our Customer Service at (920) 320-2591. Your questions will be treated with confidentiality and courtesy. To print an application click here: community care application. Once you’ve completed the printed application you may send the application to:

Holy Family Memorial
PO Box 2170
Manitowoc, WI 54221-2170

What Are My Responsibilities?

To provide the most accurate information possible with copies of all required financial documentation. (listed above in Proof of Income) Fraudulent/incomplete applications will be denied.

To pay the remaining balances in full after charitable discounts have been applied OR set up payment arrangements with appropriate billing/collection staff.

For your hospital and physician bill please contact Patient Business Services at 920-320-2591.

When approved, applicant may receive a discount on allowable services ranging from 5% to 100%. Applicants receiving 100% charitable discounts are required to pay a $5.00 co-payment for every outpatient office visit unless co-payments have been waived.

Approval under the Community Care Program does not provide exemption from collection procedures.

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